急性髓系白血病伴t（8；21）患者的长期预后

Long term outcome of acute myeloid leukemia with t（8 ;21 ）

目的探讨影响急性髓系白血病伴t（8；21）患者生存、预后的主要因素。方法对87例急性髓系白血病伴t（8；21）患者进行总结分析、随访，了解临床一般情况、免疫分型、染色体核型及治疗、生存情况，分析影响总生存（OS）、无复发生存（RFS）的因素。结果86例完成诱导治疗的急性髓系白血病伴t（8；21）患者总完全缓解（CR）率95．3％，1个疗程CR率69．8％；采用含中剂量阿糖胞苷（Ara—C）方案诱导治疗的患者1个疗程CR率达86．2％，标准剂量Ara—C方案诱导治疗的患者1个疗程CR率60．3％。87例患者的中位OS期为16．4（0．3—121．5）个月，中位RFS期为11．7（1．9～116．3）个月；3年OS率42％，5年OS率39％，3年RFS率55％，5年RFS率55％。统计学分析显示，性别、染色体核型与OS有关，其中男性患者、染色体核型伴9q-的患者预后差、生存期短；诱导缓解治疗方案、巩固治疗方案、巩固治疗疗程数亦与OS有相关性，其中采用中剂量Ara—C诱导治疗、2个疗程以上中剂量Ara—C巩固治疗、完成4个疗程以上巩固治疗的患者预后好、生存期长。结论性别、染色体核型、诱导缓解及巩固治疗的方案是影响生存、预后的主要因素，在诱导、巩固治疗中应用中剂量Ara—C，可以明显提高1个疗程缓解率，延长OS、RFS期。

Objective To investigate the influence factors on survival and outcome of acute myeloid leukemia（ AML） patients with t（8 ;21 ）. Methods Eighty seven AML patients with t（8 ;21 ）after long-term follow-up were enrolled in the analysis of clinical feature, immunophenotype, chromosome karyotype, treatment regimen, as well as the overall survival （OS） and relapse-free survival （RFS）. Results The overall complete remssion （CR） rate was 95.3%. CR rate after first course therapy was 69.8% , after first course therapy containing medium dose Ara-C was 86.2% , and after first course of therapy containing standard-dose Ara-C was 60.3%. The median OS duration was 16.4 months, median RFS 11.7 months, 3 year OS rate 42% , 5 year OS rate 39% , 3 year RFS rate 55% and 5 year RFS rate 55%. Male gender chromsome 9q - had statistical significance for shorter OS and poor outcome, 2 courses of post -remission therapy with intermediate dose Ara-C, induction theray with intermediate-dose Ara-C and post-remission with 4 courses consolidation therapy had statistically longer OS and RFS. Conclusion Sex, chromosome karyotype, induction and consolidation therapy were important influence factors on OS and RFS. Application of intermediate dose Ara-C to induction and consolidation therapy leads to a higher CR rate, prolong OS and RFS.