老年急性白血病患者50例临床特征分析

Analysis of the clinical characteristics of elderly patients with acute leukemia

目的:探讨老年急性白血病(AL)的临床特点,以利于有效治疗。方法:回顾分析50例60岁以上的老年AL患者的临床资料,包括年龄分布、基础疾病、主要症状、临床特征、骨髓(BM)象、染色体、免疫分型、化疗的完全缓解(CR)率、BM抑制程度、病程及病死率。并与同期住院的66例中青年患者进行比较。结果:老年AL发病率占同期成人AL的27%(50/185)。AML的CR率35.7%(15/42),ALL的CR率33%(2/6)。其基础疾病的发病率86%、MDS转化为AML占20%、病程(35.5±16.5)d、BM抑制时间(18.5±6.5)d、病死率20%、染色体核型为-5、-7、+8、+21,以上均高于同期的中青年组(均为P<0.01)。结论:老年AL患者并存基础疾病和染色体核型异常是其病死率高的主要原因,目前尚无早期诊断和有效治疗老年AL的满意策略,呼吁重视此方面的研究。

Objective:To discuss the clinical characteristics of elderly patients with AL in order to treat efficiently. Method:During January 2000 to May 2004, Fifty elderly patients with AL in our department were diagnosed and their clinical data were reviewed, including the age range, underlying diseases, main symptoms and clinical characteristics, BM appearance, chromosome, immunophenotype, CR rate of chemotherapy, degree of BM inhibition, disease course and mortality. These clinical data were compared with that of sixty-six younger adult AL patients(18~59 years) in the same period. Result:Morbidity of elderly AL patients was 27%(50/185) in the same period in the adult AL patients,and AML was 56.8%(42/74), ALL was 19%(8/42), CR rate of AML was 35.7%(15/42) and ALL was 33%(2/6). Underlying disease morbidity, MDS transformed AML, longer course of disease, duration of BM inhibition, mortality, karyotypic abnormalities were more prevalent in elderly AL patients than those in the younger adult AL patients(P<0.01). Conclusion:The prevalence of underlying diseases and age and karyotypic abnormalities in elderly patients might be responsible for the higher mortality in these patients with AL. At present, there are not satisfactory strategies to diagnose and treat efficiently elderly AL patients in the early stage. Calling to attach importance to this study.