141例儿童急性髓系白血病的疗效及预后相关因素分析

Study of clinical outcome and analysis of prognosis related factor in children with acute myeloid leukemia

目的评价初治儿童急性髓系白血病(AML)的疗效及探讨除急性早幼粒细胞白血病(APL)外的 AML 的预后相关因素。方法 141例18岁以下 AML 患者分成 APL 组(A 组,51例)和除APL 外的 AML 组(B 组,90例)进行回顾性研究分析。采用 Kaplan-Meier 曲线评估患者的无事件生存(EFS)率、无病生存(DFS)率和总生存(OS)率,Cox 回归模型评估预后因素。结果 B 组1个疗程完全缓解(CR)率为54.4%(49例),总缓解率为76.7%。5年累积 EFS 率、DFS 率和 OS 率分别为(28.4±9.0)%、(28.39±8.96)%和(35.5±6.3)%;A 组5年累积 EFS 率、DFS 率和 OS 率分别为(81.5±5.7)%、(94.3±4.0)%和(81.4±5.7)%:全部141例 AML 患儿5年累积 DFS 率和5年累积OS 率分别为(56.9±6.3)%和(53.3±4.8)%。B 组病例经多因素分析表明,初诊时骨髓白血病细胞比例较高和≥2个疗程达 CR 以及巩固治疗6个疗程以下是影响患者预后的危险因素(P 值均<0.05)。结论儿童 APL 预后良好。其他儿童 AML 中,初诊时骨髓原始细胞比例低和1个疗程达CR 以及巩固治疗6个疗程以上者预后较优;儿童 M_(2h)/t(8;21)与除 APL 以外的其他亚型相比没有显示预后良好的趋势;降低复发是改善儿童 AML 预后的关键。

Objective To analyse the clinical outcome and the prognostic factor of childhood acute myeloid leukemia （AML）. Methods Disease-free survival （ DFS ）, event-free survival （EFS） and overall survival（ OS）rates were estimated by Kaplan-Meier method and prognostic factors were evaluated by Cox regression with SPSS in 141 childhood AML in our hospital from August 1995 to July 2004. The patients were divided into 2 groups： acute promyelocytic leukemia（APL） as group A and AML other than APL as group B. Results Of the 90 group B patients, 54.4% （49/90） achieved complete remission （CR） after one course chemotherpy , with a total CR rate of 76.7%. The cumulative 5 year DFS and OS rate for group B patients were （28.4 ±9.0）% and （35.5±6.3）%, the 51 group A patients were （94.3 ± 4.0）% and （81.4 ± 5.7） % , and for total 141 AML patients were （56.9 ± 6.3） % and （53.3 ± 4.8） % respectively. Multi- variate analysis demonstrated that higher bone marrow blast cell percentage at diagnosis, CR after more than one course of chemotherapy and less than six courses of consolidation chemotherapy were risk prognostic factors in childhood AML other than APL （P 〈 0.05 ）. Conclusion The prognosis of childhood APL is better, while of childhood t（ 8 ;21 ） AML is no better than other FAB subtypes.