Long-term study of indolent adult T-cell leukemia-lymphoma
Long-term study of indolent adult T-cell leukemia-lymphoma
复制标题
DOI：
10.1182/blood-2009-09-242347
复制
发表时间：
2010-06-03
期刊：
影响因子：
20.3
通讯作者：
Tsukasaki, Kunihiro
中科院分区：
文献类型：
--
作者：
Takasaki, Yumi;Iwanaga, Masako;Tsukasaki, Kunihiro
成人惰性T细胞白血病淋巴瘤(ATL)的长期预后尚不清楚。对1974~2003年间新诊断的90例惰性ATL患者(慢性型65例，阴郁型25例)进行分析。中位生存期4.1年，存活10年以上12例，进展为急性ATL 44例，死亡63例。估计的5年、10年和15年生存率分别为47.2%、25.4%和14.1%，生存曲线上没有平台期。虽然大多数患者接受了警惕的等待，但仍有12名患者接受了化疗。Kaplan-Meier多因素分析显示，晚期功能状态(PS)、中性粒细胞增多、乳酸脱氢酶浓度高、结外病变3个以上、累及总病灶4个以上、接受化疗是影响预后的不良因素。多变量COX分析显示，晚期PS是生存不良的边缘显著独立因素(风险比2.1，95%可信区间1.0-4.6；P=0.06)，但当分析仅限于未接受化疗的患者时，它不是一个因素。在本研究中，惰性ATL的预后比预期的要差。这些发现表明，即使是懒惰的ATL患者也应该在临床实践中仔细观察。需要进一步的研究来开发惰性ATL的治疗方法。(血。2010；115(22)：4337-4343)
The long-term prognosis of indolent adult T-cell leukemia-lymphoma (ATL) is not clearly elucidated. From 1974 to 2003, newly diagnosed indolent ATL in 90 patients (65 chronic type and 25 smoldering type) was analyzed. The median survival time was 4.1 years; 12 patients remained alive for more than 10 years, 44 progressed to acute ATL, and 63 patients died. The estimated 5-, 10-, and 15-year survival rates were 47.2%, 25.4%, and 14.1%, respectively, with no plateau in the survival curve. Although most patients were treated with watchful waiting, 12 patients were treated with chemotherapy. Kaplan-Meier analyses showed that advanced performance status (PS), neutrophilia, high concentration of lactate dehydrogenase, more than 3 extranodal lesions, more than 4 total involved lesions, and receiving chemotherapy were unfavorable prognostic factors for survival. Multivariate Cox analysis showed that advanced PS was a borderline significant independent factor in poor survival (hazard ratio, 2.1, 95% confidence interval, 1.0-4.6; P = .06), but it was not a factor when analysis was limited to patients who had not received chemotherapy. The prognosis of indolent ATL in this study was poorer than expected. These findings suggest that even patients with indolent ATL should be carefully observed in clinical practice. Further studies are required to develop treatments for indolent ATL. (Blood. 2010; 115(22): 4337-4343)