MAJOR PROGNOSTIC FACTORS OF ADULT PATIENTS WITH ADVANCED T-CELL LYMPHOMA LEUKEMIA
MAJOR PROGNOSTIC FACTORS OF ADULT PATIENTS WITH ADVANCED T-CELL LYMPHOMA LEUKEMIA
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DOI：
10.1200/jco.1988.6.7.1088
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发表时间：
1988-07-01
影响因子：
45.3
通讯作者：
TAJIMA, K
中科院分区：
文献类型：
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作者：
SHIMOYAMA, M;OTA, K;TAJIMA, K
81例成人晚期T细胞淋巴瘤/白血病患者（包括54例成人T细胞白血病/淋巴瘤（ATL））在1981年至1983年期间接受长春新碱、环磷酰胺、泼尼松龙和多柔比星（VEPA）或VEPA+甲氨蝶呤（VEPA-M）随机治疗，评价其治疗前特征。总的完全缓解率（CR）和4年生存率分别为39.5%和19.4%，32例CR患者中69%复发，表明需要开发新的有效治疗方案。在多元逻辑回归分析中，只有三个因素，白血病的表现，性能状态（PS）差，高乳酸脱氢酶（LDH）水平，显着相关的反应率低。在考克斯比例风险模型分析中，生存期缩短与PS差和LDH水平高显著相关，但与ATL的临床诊断无关。两个因素，PS和LDH水平，这被认为是显着相关的CR和生存率，被用来构建一个模型，包含6类患者的风险增加，反应差，生存期缩短。这些类别将患者分为三组，低风险的CR和4年生存率分别为75%和53%，中度风险为45%和15%，高风险为15%和0%。结果表明，PS和LDH水平在预测晚期T细胞淋巴瘤/白血病成人患者的反应和生存方面是最重要的。除ATL外，普通型外周T细胞淋巴瘤患者的预后与晚期B细胞淋巴瘤相似。这些结果对设计新的前瞻性治疗试验具有重要意义。
Eighty-one adult patients with advanced T-cell lymphoma/leukemia including 54 with adult T-cell leukemia/lymphoma (ATL), who were treated between 1981 and 1983 with vincristine, cyclophosphamide, prednisolone, and doxorubicin (VEPA) or VEPA plus methotrexate (VEPA-M) in randomized fashion, were evaluated for pretreatment characteristics. The overall complete response (CR) and the 4-year survival rates were 39.5% and 19.4%, respectively, and 69% of 32 CR patients had relapses, indicating the need for development of new effective regimens for the disease. In a multiple logistic regression analysis, only three factors, leukemic manifestation, poor performance status (PS), and a high lactate dehydrogenase (LDH) level, were significantly associated with the poor response rate. In a Cox proportional hazards model analysis, shortened survival was again significantly associated with poor PS and ahigh LDH level, but not with a clinical diagnosis of ATL. The two factors, PS and LDH level, that were found to be significantly associated with both CR and survival rates, were used to construct a model containing six categories of patients at increasing risk for poor response and shortened survival. These categories divided the patients into three groups with respective CR and 4-year survival rates of 75% and 53% for low-risk, 45% and 15% for moderate-risk, and 15% and 0% for high-risk. The results indicate that PS and LDH levels were the most important in predicting the response and survival of an adult patient with advanced T-cell lymphoma/leukemia. The prognosis of patients with usual peripheral T-cell lymphoma, excluding ATL, was comparable with that of advanced B-cell lymphoma. These results have important implications for the design of new prospective therapeutic trials.