以吡喃阿霉素为基础的联合化疗方案治疗急性髓系白血病的疗效及其预后因素分析

Analysis of outcome and prognosis-related factors of pirarubicin-based combined chemotherapy regimen in the treatment of acute myeloid leukemia

目的：分析采用以吡喃阿霉素（pirarubicin，THP）为基础的联合方案治疗急性髓系白血病（acute myeloid leukemia，AML）患者的完全缓解（complete remission，CR）率、无病生存（disease free survival，DFS）以及总生存（overall survival，OS）情况，探讨不同预后因素对于缓解率及其预后的影响。方法：采用以THP为基础的联合方案诱导治疗初治的原发AML患者29例，计算CR率、DFS期、OS期以及1、2年的DFS率和OS率。根据患者年龄、白细胞计数、FAB分型、染色体核型以及免疫表型进行分组，比较各组之间的CR率、总体有效率[部分缓解（partial remission，PR）＋CR]和OS期（率）。结果：经1个疗程的TA（THP＋阿糖胞苷）方案诱导治疗后，19例（65．5％）患者达到CR，6例（20．7％）患者达到PR，4例（13．8％）患者未缓解（noresponse，NR），总体有效率（PR＋CR）为86．2％。19例CR患者的中位DFS期为22．9（4．0—27．0）个月，1、2年的DFS率均为77．1％。患者的中位OS期为18．6（2．0—28．1）个月，1、2年的OS率分别为58．6％和52．8％。年龄〈45岁、白细胞计数〈20×10^9／L、FAB分型为M2、染色体核型为良好和中等组、CD9和CD56阴性者的总体有效率（PR＋CR）较高。log-rank单因素分析结果显示，年龄〈45岁和FAB分型为M2者的OS期较长。结论：采用TA方案诱导治疗AML具有较好的疗效，不良反应较少。患者年龄、白细胞计数、FAB分型、染色体核型以及CD9、CD56的表达是影响治疗有效率的预后相关因素。

Objective ：To analyze the complete remission （CR） rate, disease free survival （DFS） and overall survival （OS） of acute myeloid leukemia （AML） patients treated with pirarubicin-based induction chemotherapy and explore the impact of various prognosis-related factors on the remission rate and prognosis of AML patients. Methods： Twenty-nine untreated AML patients were treated with pirarubicin-based induction chemotherapy. The CR rate, DFS and OS were calculated. All patients were divided into three or two groups according to age, white cell count （ WBC）, French-American-British （FAB） morphology, karyotype and immunophynotype re- spectively. Differences in CR rate, remission rate （ CR ＋ PR） and OS among different groups were compared. Results：The CR, partial remission （PR） and non-remission （NR） rate of all the 29 cases was 65.5% （19/29） , 20.7% （ 6/29 ） , and 13.8% （4/29）, respectively. The median DFS of the 19 CR patients was 22.9 （ ranged from 4.0-27.0） months, DFS rates at 1 and 2 years were both 77.1%. The median OS of the 29 patients was 18.6 （ ranged from 2.0 to 28.1 ） months. OS rates at 1 and 2 years were 58.6% and 52.8%, respectively. Younger than 45 years old, WBC 〈 20×10^9/L, FAB-M2 morphology, favorable and intermediate karyotype, CD9 or CD56 negative group had higher remission rate. Log rank univariate analysis showed that age （ 〈 45 years old ） and FAB-M2 morphology were associated with a longer OS. Conclusion ：These results suggest that use of pirarubicin-based induction regimen was ef- fective and safe for AML. Age, WBC, FAB morphology, karyotype, and CD9/CD56 expression are prognosis-related factors for clinical outcome.