培训课件_成人急性淋巴细胞白血病诊治进展低分下载.ppt

* Karyotype is an independent prognostic factor in adult acute lymphoblastic leukemia (ALL): analysis of cytogenetic data from patients treated on the Medical Research Council (MRC) UKALLXII/Eastern Cooperative Oncology Group (ECOG) 2993 trial. Blood，2007，109：3189-3197. low hypodiploidy (30-39 chromosomes)/near triploidy (60-78 chromosomes)(Ho-Tr); high hyperdiploidy (51-65 chromosomes) (HeH), karyotypes with 60 to 65 chromosomes were examined individually and classified as HeH or Ho-Tr according to whether the pattern of chromosomal gain was closest to the classical description of HeH or Ho-Tr. MRC UKALL Ⅻ/ECOG E2993试验对1522例病人进行了细胞遗传学分析，涉及20余种异常染色体，结果显示Ph-病人5年EFS和5年OS分别是38%和42%，而Ph+病人5年EFS和5年OS分别是16%和22%，在Ph-病人中，具有t（4；11）（q21;q23）,t(8;14)(q24.1;q32),复杂核型(5种或5种以上染色体异常)，低亚二倍体/近三倍体（low hypodiploidy/near triploidy,Ho-Tr）等核型的病人预后不良，其5年EFS和5年OS分别是24%和24%，13%和13%，21%和28%，18%和22%，而具有高超二倍体（high hyperdiploidy,HeH）或del(9P)核型的病人其预后明显改善，其5年EFS和5年OS分别是50%和53%，49%和58%，其他核型则与疾病预后无明显相关性。多变量因素分析表明t(8;14)，复杂核型，Ho-Tr在Ph-病人中是独立于性别，年龄，WBC计数和T细胞亚型的预后因素。 * Induction therapy for adults with acute lymphoblastic leukemia: results of more than 1500 patients from the international ALL trial: MRC UKALLXII/ECOG E2993. Blood, 2005 106: 3760-3767. * Clinical significance of minimal residual disease quantification in adult patients with standard-risk acute lymphoblastic leukemia .Blood，2006，107:1116-1123. * Treatment of Adult Acute Lymphoblastic Leukemia. American Society of Hematology, 2006. * Treatment of Adult Acute Lymphoblastic Leukemia. American Society of Hematology, 2006. * 参见Allogeneic transplantation for ALL in adults. Bone Marrow Transplantation ，2008，41：439–446. * 参见Allogeneic transplantation for ALL in adults. Bone Marrow Transplantation ，2008，41：439–446. * Aversal, et al. Journal of Clinical Oncology, 2005, 23: 3447-3454. * Which Patients with Adult Acute Lymphoblastic Leukemia Should Undergo a Hematopoietic Stem Cell Transplantation? Case-Based Discussion. American Societ