Part One Optimal Treatment Of Adult Ph Negative Acute Lymphoblastic Leukemia Part Two The Impact Of Risk Stratification On The Duration Of Caspofungin Therapy For Unclassified Episodes Of Invasive Fungal Disease In Patients With Acute Leukemia

Background:Ph negative acute lymphoblastic leukemia is highly heterogeneous and no uniform chemotherapy regimen for this.Great differences exist in different regimen and different age.The therapeutic effect of adult Ph negative ALL cann't be improved significently by traditional regimen.The pediatric inspired regimen was used more and more in the treatment of adult Ph negative ALL because of its good therapeutic effect.Objective:To analyze the difference of safety and therapeutic effect between the traditional and the pediatric inspired ALL chemotherapy regimens.To explore whether patients in different age group will benefit from definite regimen.Methods:Adult de novo Ph negative ALL patients in our hospital from Jan 4,2009 to Sep 4,2013 were involved in this research and received the two different treatment including traditional regimen(regimen NO.1)and modified pediatric regimen(regimen NO.2)respectively.To evaluate the safety and the therapeutic effect for the whole patients and for different stratification statistically.Results:All 144 patients had received the induction therapy.The total CR rate was 95.8%,one course CR rate was 92.4%.5 years OS and RFS were 59.0%and 48.6%respectively.The CR rate,3 years OS and 3 years RFS between the two different regimen was 95.6%vs 96.1%(P=0.783),65.3%vs 63.4%(P=0.885),56.0%vs 50.0%,(P=0.931)respectively.Further analysis stratified with age was also performed.For the patients received regimen NO.1,the 3 years OS and RFS between the two different age group(14-30 years and 31-60 years)was 69.6%vs 54.7%(P=0.042)and 56.5%vs 57.0%(P=0.472).For the patients received regimen N0.2,the 3 years OS and RFS between the two different age group(14-30 years and 31-60 years)was 65.7%vs 60.3%(P=0.423)and 51.5%vs 46.6%(P=0.655).No differences were found on the respiratory failure,cardiac dysfunction,fungal infection and intestinal obstruction between the two groups.The incidence of renal dysfunction for regimen NO.1 was lower than regimen NO.2(P=0.011).The incidence of bacteremia for regimen NO.1 was higher than regimen NO.2(P=0.000).Conclusion:The two regimens used by adult Ph negative ALL patients were well tolerated and showed relative favorable CR rate and long term survival rate.the older patients(31-60 years)tended to benefit from the regiment NO.2 which was less intensive but contained more non-bone marrow suppression agents.Background:The acute leukemia patients were constantly under the risk of invasive fungal infection(IFI)during the chemotherapy in 5-10%of patients,invasive fungal infection is associated with mortality rate of 30%to 90%.(1)So to reduce the incidence of IFI and mortality related with IFI,the safe and effective antifungal prophylaxis is necessary.Caspofungin has been proved to be effective for therapy of invasive fungal infection.Considering the therapeutic effect and perfect safety of caspofungin,(2,3)it is especially suitable for acute leukemia with invasive fungal infection,because these patients are always complicated by some organ damage.Caspofungin was always sequenced by Voriconzole tablet in considering about the cost and the compliance.Except the safety and efficacy issue,when the infection was in stable condition,the proper duration of Caspofungin has't been confirmed.Objective:As the optimum duration of antifungal treatment for patients with'unclassified' invasive fungal disease(IFD)remains ill-defined,we retrospectively analyzed 141 patients with unclassified IFD episodes who were undergoing treatment for acute leukemia.Methods:Patients were divided into standard-risk and high-risk groups and treated with IV caspofungin for either 1 or 2 weeks,followed by oral voriconazole.Results:Favorable responses occurred in 75.9%of patients(107/141)overall.Although there were no significant differences in response rates at 2 and 4 weeks between patients receiving 1 or 2 weeks of caspofungin treatment in the standard-risk group(P=0.12 and P=0.19,respectively),in the high-risk group,response rates at 2 and 4 weeks were significantly higher in the 2-week treatment group than the 1-week treatment group(P=0.01 and P=0.02,respectively).Conclusions:The duration of caspofungin treatment for patients with unclassified IFDs may be optimized by risk stratification.Adequate duration(two weeks)of caspofungin should be given for the high-risk patients.While one week of caspofungin is enough for the standard-risk patients.