Clinical Analysis Of The Related Factors To The Outcomes Of Induction Chemotherapy In Acute Leukemia

Acute leukemia (AL) is a malignancy with the clonal expansion ofstemsell,which have a very poor prognostic whithout treatment. The therapyof AL is including: combination chemotherapy, stem cell transplantation andtargeted therapy. Chemotherapy ,which including induction chemotherapy andconsolidation chemotherapy, is the most importance of all. In adult acutelymphoblastic leukemia(ALL),the complete remission(CR) rates of 70%-85%can be achieved,and the non-lymphoblastic leukemia 60%. It's very importantto get CR as early as we can ,which is the base of following treatment and thelong serveval. The purpose of the current study is to know the clinicalcharacteristics which effect the outcomes of the induction chemotherapy inprimary acute leukemia ,and the instruct us to administ more effectivechemotherapy regimen.Methods: Retros pective study was carried out on 93 patients withprimary AL patients who seeked medical services in our hospital from 2002 to2004.Results: 1.The subtype of the AL is an important factor impact to theoutcomes the induction chemotherapy .The CR rate of Patients with ALL is67.6%,whereas the CR rate of patients with ANLL is 45.1%,which is lowerthan ALL group (P<0.05).None of the five HAL in our study reached CR.2.There was a progressive worsening in CR rate with increasing age.In thoseover 60,none of the 4 patients whith ALL and only 2 of the 8 patients whithANLL reached CR. complications, deaths in remission and history ofmylodisplastic syndrome are increased significantly with age. 60% of theANLL patients aged 50-60 were administed the IDA regimen,and the CR ratewas 62.5%.3.There was on differents of the symptoms between the CR groupand groupwhich didn't reach CR( P<0.05) . 4.There were 22 patientscomplicate whith the other system changes,and the CR rate is 22.2%,18.2%deathed in remission,which significantly different from those withoutcomplications(P<0.05). 5. There was a progressive decrease in CR rate withincreasing of peripheral white blood cell count,and a increase in CR rate withincreasing of hemoglobin and platelet count. The average white blood cellcount of CR group was lower and the Hgb was higher than those group whichdidn't achieve CR ( P<0.05 ) .In Patients whith ALL the CR rate ofWBC>100×109/L group is lower than those WBC<100×109/L group (16.7%vs70.9%), the CR rate in ANLL of WBC>100×109/L group is 12.5% which islower than that of WBC<100×109/L group,which is 51%(P<0.05). In Patientswhith ALL the CR rate of Hgb<100g/L group is lower than those Hgb>100g/Lgroup (50%vs 84.6%), the CR rate in ANLL of Hgb<100g/L group is 36.6%which is lower than that of Hgb>100g/L group,which is 80%(P<0.05). therewas no difference of CR rate between the platelet count >30×109/L and that<30×109/L(P>0.05). 6. The average blast cell in bone marrow is lower in CRgroup than that in the group didn't reached CR(P<0.05).7.The CR rate ofALL whith extramedullary disease is 53.6%,lower than that whithoutextromedullary disease which is 88.9%(P<0.05). The CR rate of ANLL whithextramedullary disease is 32.1%,lower than that whithout extromedullarydisease which is 60.9%(P<0.05).8,In patients whith ALL the average lactatedehydronase (494.05±374.54U/L) in CR group is lower than that group didn'treached CR(2277.14±801.09 U/L) (P<0.05). In patients whith ANLL theaverage lactate dehydronase (398.55±301.03 U/L) in CR group is lower thanthat group didn't reached CR(762.71±450.15 U/L) (P<0.05);The CR rate ofALLwhith LDH>600 U/L is 33% lower than that whith LDH≤600 U/Lwhichis 88.9%(P<0.05). The CR rate of ANLLwith LDH>600 U/L is 26.5%lowerthan that with LDH≤600 U/Lwhich is 64.3%(P<0.05).9.The CR rate ofPh/BCR-ABL positive ALL is 20%,lower than that of Ph/BCR-ABL negativeALL(P<0.05).At the same time our study show that there were otherpredictors in the Ph/BCR-ABL positive ALL. The CR rate oft(8:21)/AML-ETO positive ANLL is 75%,but there were no difference whiththat of t(8:21)AML/ETO negative ANLL(P>0.05).In our study none of the 5patients whith multichange of karyotype reached CR . 10.immunophenotypeof 49 patients in our study can be learned by multiparameter flow cytometry .The CR rate of the AL whith lineage specific antigens expressed is 60.6%, issignificently higher than that of biphenotypic ALL which is 25%.(P<0.05).The CR rate of T-lineage antigen expressed ALL (B-ALL) ishigher than that of B-lineage antigen expressed.The prognostic of CD14 orCD34 positive AL is better than that negative AL(P<0.05). Conclusion: As a result, we draw the following conclusions : (1)Thesubtype of the AL is an important factor impact to the outcomes the inductionchemotherapy . The CR rate of Patients with ALL is highter than that ofpatients with ANLL,the prognostic of HAL is poor. (2)There was aprogressive worsening in CR rate with increasing age.the outcomes ofinduction chemotherapy In those over 60 is poor. complications, deaths inremission and history of mylodisplastic syndrome are increased significantlywith age. (3) The outcomes of the induction chemotherapy In the patientscomplicate whith the other system changes is poor. (4) There was aprogressive decrease in CR rate with increasing of WBC or decreasing of Hgb.