Abstract:

Objective To analyze the survival and prognostic factors of adult acute lymphoblastic leukemia (ALL) with different consolidation regimens after complete remission by induction therapy. Methods A total of 93 adult patients with ALL were enrolled from January 2012 to June 2019 in Peking University Shenzhen Hospital. All the patients achieved complete remission induced by VDLCP regimen, and were divided into the standard group, intensive group and transplantation group according to the consolidation treatment. Thirty-four patients in the standard group received an ALL-like chemotherapy regimen based on VDLCP or Hyper-CVAD consolidation for 4-6 courses. Twenty-nine patients in the intensive group received BFM90/95 consolidation treatment for 2 years. Thirty patients in the transplantation group received allogeneic hematopoietic stem cell transplantation (allo-HSCT) after 2-3 courses of consolidation with the original induction regimen. The median follow-up was 18 (3-96) months, and the main follow-up indicators were overall survival (OS) and disease free survival (DFS). Prognostic factors of adult ALL patients and treatment-related deaths in each group were analyzed. Results The 3-year OS rates of the standard group, intensive group and transplantation group were 54.0% (95%CI: 35.3%-72.6%), 71.8% (95%CI: 41.0%-94.5%), 62.3% (95%CI: 43.6%-80.9%), with a statistically significant difference (χ²=6.110, P=0.047). The 3-year DFS rates of the three groups were 31.4% (95%CI: 12.9%-49.8%), 72.1% (95%CI: 52.3%-91.9%), 65.7% (95%CI: 45.3%-86.1%), with a statistically significant difference (χ²=13.831, P=0.001). There were no significant differences in OS and DFS between the intensive group and the transplantation group (χ²=0.709, P=0.400; χ²=0.046, P=0.830). OS and DFS of the intensive group were better than those of the standard group (χ²=5.346, P=0.021; χ²=10.326, P=0.010). Multivariate analysis suggested that bone marrow minimal residual disease (MRD) negative on day 14-21 of chemotherapy was an independent prognostic factor affecting adult ALL (HR=0.114, 95%CI: 0.015-0.841, P=0.033). The 3-year OS rates of Ph⁺ALL patients who received and did not receive allo-HSCT were 53.5% (95%CI: 23.1%-83.8%), 52.4% (95%CI: 23.8%-81.0%), the 3-year DFS rates were 77.1% (95%CI: 54.2%-100.0%), 35.0% (95%CI: 4.8%-65.2%), and there were no significant differences between the two groups (χ²=3.600, P=0.223; χ²=3.824, P=0.050). The treatment-related mortalities of the non-transplantation group (standard group + intensive group) and the transplantation group were 3.2% (2/63) and 20.0% (6/30), and the treatment-related mortality of the non-transplantation group was significantly lower than that of the transplantation group (χ²=7.318, P=0.007). Conclusion Adult ALL has a poor prognosis. The 3-year OS rate and 3-year DFS rate of BFM intensive consolidation therapy are better than those of standard consolidation therapy, achieving a similar effect to allo-HSCT, but treatment-related mortality does not increase significantly. Patients with bone marrow MRD negative on the day 14-21 of chemotherapy have the better OS and DFS.

Key words: Precursor cell lymphoblastic leukemia-lymphoma, Clinical features, Overall survival, Disease-free survival, Allogeneic hematopoietic stem cell transplantation