title: [Therapeutic Efficacy of VICP+L-ASP/TKI on Adult Patients with B-ALL].
abstract: OBJECTIVE
  To evaluate the therapeutic efficacy of VICP+L-ASP/TKI on adult patients with B-ALL and to explore the influence factors.
  
  
  METHODS
  Forty-one adult B-ALL patients treated with VICP+L-ASP/TKI from August 2008 to June 2014 were following-up. The complete remission(CR) rate, toxicity, overall survival(OS) and event free survival(EFS) after induction treatment were analyzed, the therapeutic outcome of patients between different risk stratification subgroups was compared, the influence of standardized consolidatory and maintaining treatment as well as allogeneic hematopoietic stem cell transplantation(allo-HSCT) on survival time was analyzed.
  
  
  RESULTS
  The early death not occurred in 41 patients with B-ALL including 37 cases with CR; the CR rate of 1 course treatment was 90.2%. The follow-up time lasted to March 17, 2015, the median follow-up time was 25(9-79) months; the 1 year OS rate was 75.3%, the EFS rate was 58.3%. Analysis of risk factors showed that the initial WBC count over 30×109/L, LDH over 250 U/L and minimal residual disease(MRD) over 10-4after treatment were poor prognostic factors. After remission, the standardized consolidatory treatment or allo-HSCT according to the "2012 China adult ALL diagnosis and treatment expert consensus" could improve long-term survival, 3 years OS rate was 73.8% and 61.5% respectively, 3 years EFS were 63.5% and 65.7% respectively. The main toxic and side effects were hematologic reactions, the hematologic adverse reaction of IV grade was observed in 97.6%(40/41) during induction treatment.
  
  
  CONCLUSIONS
  Induction chemotherapy based on VICP+L-ASP/TKI and standardized consolidatory after remission according to the "2012 China adult acute lymphoblastic leukemia diagnosis and treatment expert consensus" can improve the therapeutic efficacy. The allo-HSCT should be actively performed for B-ALL paients with high risk(elevated initial WBC count and LDH level); at some time, the regularly monitoring MRD and adjusting therapeutic protocol according to monitoring result can promote the prognosis of adult B-ALL patients.
authors.affiliation: Department of Hematology, Jiaxing First Hospital, Jiaxing 314001, Zhejiang Province, China.
authors.forename: Ming-Fang
authors.initials: MF
authors.lastname: Shen
authors.affiliation: Department of Hematology, The First Affiliated Hospital of Zhejiang University Medical School, Hangzhou 310003, Zhejiang Province, China. E-mail: weijuy@yhotmail.com.
authors.forename: Ju-Ying
authors.initials: JY
authors.lastname: Wei
authors.affiliation: Department of Hematology, The First Affiliated Hospital of Zhejiang University Medical School, Hangzhou 310003, Zhejiang Province, China.
authors.forename: Wen-Juan
authors.initials: WJ
authors.lastname: Yu
authors.affiliation: Department of Hematology, The First Affiliated Hospital of Zhejiang University Medical School, Hangzhou 310003, Zhejiang Province, China.
authors.forename: Jing-Han
authors.initials: JH
authors.lastname: Wang
authors.affiliation: Department of Hematology, The First Affiliated Hospital of Zhejiang University Medical School, Hangzhou 310003, Zhejiang Province, China.
authors.forename: Hong-Yan
authors.initials: HY
authors.lastname: Tong
authors.affiliation: Department of Hematology, The First Affiliated Hospital of Zhejiang University Medical School, Hangzhou 310003, Zhejiang Province, China.
authors.forename: Hai-Tao
authors.initials: HT
authors.lastname: Meng
authors.affiliation: Department of Hematology, The First Affiliated Hospital of Zhejiang University Medical School, Hangzhou 310003, Zhejiang Province, China.
authors.forename: Wen-Yuan
authors.initials: WY
authors.lastname: Mai
authors.affiliation: Department of Hematology, The First Affiliated Hospital of Zhejiang University Medical School, Hangzhou 310003, Zhejiang Province, China.
authors.forename: Wen-Bin
authors.initials: WB
authors.lastname: Qian
authors.affiliation: Department of Hematology, The First Affiliated Hospital of Zhejiang University Medical School, Hangzhou 310003, Zhejiang Province, China.
authors.forename: Jie
authors.initials: J
authors.lastname: Jin
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols; D002681:China; D018572:Disease-Free Survival; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D060828:Induction Chemotherapy; D007958:Leukocyte Count; D018365:Neoplasm, Residual; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma; D011379:Prognosis; D012074:Remission Induction; D012307:Risk Factors