title: [Prognostic factors of adult Philadelphia chromosome negative acute lymphoblastic leukemia].
abstract: OBJECTIVE
  To analyze the prognostic factors in adult Philadelphia chromosome negative acute lymphoblastic leukaemia (Ph⁻ ALL).
  
  
  METHODS
  From December 1999 to December 2013, 353 consecutive hospitalized 18-65-year-old adult Ph⁻ ALL patients were retrospectively analyzed. Induction therapy was CODP±L-asparaginase (L-Asp) regimen, and consolidation therapy included CODP and high dose methotrexate or revised Hyper-CVAD A and B regimens for 8 cycles. 178 patients (50.4%) performed allo-HSCT after three to five cycles of consolidation treatment, and 172 patients didn't receive allo-HSCT. The median follow-up was 39.9 months (2.0 to 171.0 months) for the 184 survivors.
  
  
  RESULTS
  Three patients (0.85%) happened early death. CR rate after the first cycle of induction chemotherapy was 77.4% (271/350) among evaluated 350 patients. Overall CR rate was 92.9% (325/350). WBC ≥ 100.0 × 10⁹/L (P=0.010) and hepatomegaly/splenomegaly/lymphadenopathy (P=0.036) were independent adverse factors for overall CR. Among the 325 CR patients, 117 patients developed relapse, cumulative incidence of relapse (CIR) at 5 years was 43.2%, disease-free survival (DFS) and overall survival (OS) rates at 5 years were 44.7% and 45.6% respectively. Multivariate analysis showed that harboring central nervous system leukaemia (CNSL) at diagnose (P=0.004, P=0.002, P<0.001, respectively), induction regimen without L-Asp (P=0.023, P=0.009, P=0.004, respectively), time to CR more than 4 weeks (P=0.034, P=0.024, P=0.003, respectively), and non-allo-HSCT (P<0.001, P<0.001, P<0.001, respectively) were adverse factors of relapse, DFS and OS. In addition, high WBC count at diagnosis (≥ 30.0 × 10⁹/L for B lineage and ≥ 100.0 × 10⁹/L for T lineage) was poor factor of DFS (P=0.044). Based on the four adverse prognostic factors of DFS above mentioned (including WBC at diagnose, harboring CNSL at diagnose, induction regimen with or without L-Asp, time to CR more than 4 weeks), patients were grouped into low risk (no factor), intermediate risk (one factor), and high risk (at least two factors). Non-allo-HSCT and allo-HSCT had similar outcomes in low risk subgroup. Allo-HSCT significantly improved OS and DFS in intermediate and high risk subgroups rather than non-allo-HSCT (all P values < 0.001).
  
  
  CONCLUSIONS
  In adult Ph- ALL patients, high WBC count at diagnosis (≥ 30.0 × 10⁹/L for B lineage and ≥ 100.0 × 10⁹/L for T lineage), CNSL at diagnosis, induction regimen without L-Asp, time to CR more than 4 weeks and non-allo-HSCT were adverse prognostic factors. Allo-HSCT improved OS and DFS in patients with more than one of the first four adverse prognosis factors.
authors: Peking University People's Hospital, Peking University Institute of Hematology, Beijing 100044, China.
authors: Jing
authors: J
authors: Wang
authors: Peking University People's Hospital, Peking University Institute of Hematology, Beijing 100044, China.
authors: Xiaojun
authors: X
authors: Huang
authors: Peking University People's Hospital, Peking University Institute of Hematology, Beijing 100044, China.
authors: Bin
authors: B
authors: Jiang
authors: Peking University People's Hospital, Peking University Institute of Hematology, Beijing 100044, China.
authors: Jinsong
authors: J
authors: Jia
authors: Peking University People's Hospital, Peking University Institute of Hematology, Beijing 100044, China.
authors: Shenmiao
authors: S
authors: Yang
authors: Peking University People's Hospital, Peking University Institute of Hematology, Beijing 100044, China.
authors: Li
authors: L
authors: Bao
authors: Peking University People's Hospital, Peking University Institute of Hematology, Beijing 100044, China.
authors: Hao
authors: H
authors: Jiang
authors: Peking University People's Hospital, Peking University Institute of Hematology, Beijing 100044, China.
authors: Jin
authors: J
authors: Lu
authors: Peking University People's Hospital, Peking University Institute of Hematology, Beijing 100044, China.
authors: Honghu
authors: H
authors: Zhu
authors: Peking University People's Hospital, Peking University Institute of Hematology, Beijing 100044, China.
authors: Ting
authors: T
authors: Zhao
authors: Peking University People's Hospital, Peking University Institute of Hematology, Beijing 100044, China.
authors: Qian
authors: Q
authors: Jiang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D018572:Disease-Free Survival; D006801:Humans; D060828:Induction Chemotherapy; D008875:Middle Aged; D010677:Philadelphia Chromosome; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies; D015996:Survival Rate; D055815:Young Adult
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