诱导化疗期定时骨髓象检查在急性髓细胞白血病预后判断中的价值

The prognostic significance of regular bone marrow aspirations during induction chemotherapy in acute myeloid leukemia

目的：分析诱导化疗期骨髓象检查结果与预后的关系。方法：对９６例原发、初治急性髓细胞白血病（ＡＭＬ）患者，于诱导化疗第１疗程期间定时作骨髓穿刺检查。结果：化疗第７天骨髓中幼稚细胞≤０．１０的患者１个疗程完全缓解（ＣＲ）率明显高于幼稚细胞＞０．１０的患者（分别为６４．６％和４０％，Ｐ＜０．０５）。对幼稚细胞＞０．１０的患者适当延长化疗时间可提高１个疗程ＣＲ率（５０％∶２５％，但与不延长化疗组相比无统计学差异）。停化疗后ＷＢＣ降至最低时骨髓中幼稚细胞比例和预后更具显著相关性，幼稚细胞≤０．１０的患者１个疗程ＣＲ率明显高于幼稚细胞＞０．１０的病例（６６．０％∶２５．８％，Ｐ＜０．００５），而难治病例发生率显著减少（７．５％∶４５．２％，Ｐ＜０．００５）。结论：诱导化疗期定时骨髓象检查有助于估计预后、指导治疗和改善疗效。

Objective:To evaluate the prognostic significance of regular aspirations during induction chemotherapy in acute myeloid leukemia.Methods:Regular bone marrow aspirations were performed during the first course of induction chemotherapy in 96 cases of de novo AML.Results:Complete remission (CR) rate after the first course in patients with ≤0.10 bone marrow blasts at the 7th day on chemotherapy was higher than that in patients with >0.10 blasts (64.6% vs 40.0%,P<0.05).Prolonged the chemotherapy course for a few more days in the latter group of patients increased CR rate from 25.0% to 50.0%.CR rate in patients with ≤0.10 bone marrow blasts at the nadir of white blood cell count after chemotherapy was higher than that in patients with >0.10 blasts (66.0%vs 25.8%,P<0.005),and the refractory cases were significantly fewer in the former group of patients (7.5% vs 45.2%,P<0.005).Conclusion:Regular bone marrow aspirations during induction chemotherapy were helpful in predicting the prognosis and guiding the treatment in AML.