Acute Lymphoblastic Leukemia in Routine Practice: A Turkish Multicenter StudyRafiye Çiftçiler1, Omur Gokmen Sevindik2, Ali İrfan Emre Tekgündüz3, Mehmet Ali Ertürk4, Filiz Vural5, Burhan Turgut6, Leylagül Kaynar7, Bahriye Payzın8, Mehmet Hilmi Doğu9, Volkan Karakuş10, Fevzi Altuntaş11, Yahya Büyükaşık1, Fatih Demirkan121Hacettepe University Faculty of Medicine, Department of Hematology, Ankara, Turkey
2Medipol University Hospital, Clinic of Hematology, İstanbul, Turkey
3Memorial Bahçelievler Hospital, Clinic of Hematology, İstanbul, Turkey
4İnönü University Faculty of Medicine, Department of Hematology, Malatya, Turkey
5Ege University Faculty of Medicine, Department of Hematology, İzmir, Turkey
6Namık Kemal University Faculty of Medicine, Department of Hematology, Tekirdağ, Turkey
7Erciyes University Faculty of Medicine, Department of Hematology, Kayseri, Turkey
8İzmir Atatürk Training and Research Hospital, Clinic of Hematology, İzmir, Turkey
9İstanbul Training and Research Hospital, Clinic of Hematology, İstanbul, Turkey
10Muğla Sıtkı Koçman University Faculty of Medicine, Department of Hematology, Muğla, Turkey
11Ankara Oncology Training and Research Hospital, Clinic of Hematology, Ankara, Turkey
12Dokuz Eylül University Faculty of Medicine, Department of Hematology, İzmir, Turkey
Objective: Significant developments occurred in the clinical management of acute lymphoblastic leukemia (ALL) in adults in recent decades. However, treatment results are still not satisfactory, especially in routine practice. The objective of this study was to evaluate the general clinical features, treatment details, and outcomes of a large group of patients followed in multiple centers in Turkey with a diagnosis of ALL.
Materials and Methods: A retrospective analysis of the data of patients with ALL was made, the patients having been diagnosed and treated between January 2003 and June 2017 by different protocols in the hematology clinics of ten different centers. A total of 288 patients, aged between 17 and 76 years old, were included in the study. In this retrospective multicenter analysis of patients with ALL, classification of patients was performed based on treatment period, Philadelphia chromosome positivity, treatment regimen, and administration of allogeneic hematopoietic stem cell transplantation (allo-HSCT).
Results: The majority of cases were B-cell in origin, while 224 patients had B-ALL and 64 of the patients had T-ALL. Median follow-up duration for all patients was 18.2 months (range: 0.03-161 months). Philadelphia chromosome positivity was determined in 49 patients (21.9%), and 54 patients (18.8%) were receiving allo-HSCT. After induction chemotherapy, 219 patients (76.0%) achieved complete remission, 32 patients (11.2%) were evaluated as treatment refractory, and 37 patients (12.8%) were deceased. Median overall survival was 47.7 months (95% confidence interval: 36.1-59.2) and median disease-free survival was 23.4 months (95% confidence interval: 6.7-40.0) for all patients.
Conclusion: Multicenter studies are extremely important for defining the specific clinical features of a particular disease. The results of this study will make a significant contribution to the literature as they reflect real-life data providing valuable information about the Turkish ALL patient profile.
Keywords: Akut lenfoblastik lösemi, Pediatrik rejim, Pediatrik rejimden ilham alan rejim, Philadelphia kromozomu
Rutin Uygulamada Akut Lenfoblastik Lösemi: Türkiye’den Çok Merkezli Bir ÇalışmaRafiye Çiftçiler1, Omur Gokmen Sevindik2, Ali İrfan Emre Tekgündüz3, Mehmet Ali Ertürk4, Filiz Vural5, Burhan Turgut6, Leylagül Kaynar7, Bahriye Payzın8, Mehmet Hilmi Doğu9, Volkan Karakuş10, Fevzi Altuntaş11, Yahya Büyükaşık1, Fatih Demirkan121Hacettepe University Faculty of Medicine, Department of Hematology, Ankara, Turkey
2Medipol University Hospital, Clinic of Hematology, İstanbul, Turkey
3Memorial Bahçelievler Hospital, Clinic of Hematology, İstanbul, Turkey
4İnönü University Faculty of Medicine, Department of Hematology, Malatya, Turkey
5Ege University Faculty of Medicine, Department of Hematology, İzmir, Turkey
6Namık Kemal University Faculty of Medicine, Department of Hematology, Tekirdağ, Turkey
7Erciyes University Faculty of Medicine, Department of Hematology, Kayseri, Turkey
8İzmir Atatürk Training and Research Hospital, Clinic of Hematology, İzmir, Turkey
9İstanbul Training and Research Hospital, Clinic of Hematology, İstanbul, Turkey
10Muğla Sıtkı Koçman University Faculty of Medicine, Department of Hematology, Muğla, Turkey
11Ankara Oncology Training and Research Hospital, Clinic of Hematology, Ankara, Turkey
12Dokuz Eylül University Faculty of Medicine, Department of Hematology, İzmir, Turkey
Amaç: Son yıllarda erişkinlerde akut lenfoblastik löseminin (ALL) tedavi yönetiminde önemli gelişmeler meydana gelmiştir. Bununla birlikte, özellikle rutin uygulamada tedavi sonuçları hala tatmin edici değildir. Çalışmanın amacı, Türkiye’de birden fazla merkezde takip edilen geniş bir ALL hasta grubunun genel klinik özelliklerini, tedavi özelliklerini ve sağkalım sonuçlarını değerlendirmektir.
Gereç ve Yöntem: Ocak 2003 ile Haziran 2017 tarihleri arasında on farklı merkezdeki hematoloji kliniğinde tanı konulan ve farklı protokollerle tedavi edilen ALL hastalarının verilerinin retrospektif analizi yapıldı. Çalışmaya yaşları 17 ile 76 arasında değişen toplam 288 hasta dahil edildi. Bu çalışmada ALL’li hastalar tedavi periyoduna, Philadelphia kromozom pozitifliğine, tedavi protokolü ve allojenik hematopoetik kök hücre nakli (AHKHN) yapılıp yapılmamasına göre sınıflandırıldı.
Bulgular: Olguların 224’ü B-ALL, 64’ü T-ALL idi. Tüm hastalar için ortanca takip süresi 18,2 ay (dağılım, 0,03-161 ay) idi. Philadelphia kromozomu (Ph+) pozitifliği 49 (%21,9) hastada saptandı ve 54 hastaya (%18,8) AHKHN yapıldığı izlendi. İndüksiyon kemoterapisinden sonra 219 hasta (%76) tam remisyona girdi, 32 hasta tedaviye refrakter (%11,2) olarak değerlendirildi, 37 hastada ise (%12,8) mortalite gözlendi. Ortanca genel sağkalım 47,7 ay (%95 güven aralığı: 36,1-59,2) ve ortanca hastalıksız sağkalım tüm hastalar için 23,4 ay (%95 güven aralığı: 6,7-40,0) idi.
Sonuç: Sonuç olarak, çok merkezli çalışmalar, belirli bir hastalığın spesifik klinik özelliklerini tanımlamak için büyük öneme sahiptir. Bu çalışmanın sonuçları, Türk ALL hasta profili hakkında değerli bilgiler sağlayan gerçek hayat verilerini yansıttığı için literatüre önemli bir katkı sağlayacaktır.
Anahtar Kelimeler: Akut lenfoblastik lösemi, Pediatrik rejim, Pediatrik rejimden ilham alan rejim, Philadelphia kromozomu
Rafiye Çiftçiler, Omur Gokmen Sevindik, Ali İrfan Emre Tekgündüz, Mehmet Ali Ertürk, Filiz Vural, Burhan Turgut, Leylagül Kaynar, Bahriye Payzın, Mehmet Hilmi Doğu, Volkan Karakuş, Fevzi Altuntaş, Yahya Büyükaşık, Fatih Demirkan. Acute Lymphoblastic Leukemia in Routine Practice: A Turkish Multicenter Study. Turk J Hematol. 2019; 36(3): 169-177
Corresponding Author: Rafiye Çiftçiler, Türkiye |
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