急性髓系白血病患者预后分组方式的探讨

A new prognostic stratification for patients with acute myeloid leukemia

目的评价原发、初治急性髓系白血病（AML）患者诱导治疗后不同时间骨髓幼稚细胞比例对预后的影响。将细胞遗传学与诱导治疗后不同时间骨髓幼稚细胞比例相结合，提出新的AML患者预后分组方法。方法回顾性分析1999年1月1日至2008年2月1日于我院住院的原发、初治AML患者（非M3型）105例，所有患者在诱导化疗结束时（T1）和（或）骨髓抑制期（T2）进行骨髓穿刺检查。有细胞遗传学资料的患者97例。结果（1）T1或12时间点105例行骨髓穿刺检查的患者，骨髓幼稚细胞〈0．05者和I〉0．05者相比，T1时间点完全缓解（CR）率分别为86．0％、47．4％，3年无复发生存（RFS）率分别为46．2％、21．6％，3年总生存率分别为49．7％、25．6％。12时间点二者CR率分别为86．3％、41．4％，3年RFS率分别为52．4％、18．9％，3年总生存率分别为61．1％、35．2％，差异均有统计学意义。且T1和T2时间点骨髓幼稚细胞比例具有相关性。（2）将染色体核型预后中等组患者根据T1或T2时间点骨髓幼稚细胞比例分为二组：骨髓幼稚细胞〈0．05者和I〉0．05者。前者预后与良好组相近，后者预后与不良组相近。（3）多因素分析表明T1或他时间点骨髓幼稚细胞比例是AML患者的独立预后因素。T1时间点骨髓幼稚细胞比例可能较亿时间点骨髓幼稚细胞比例意义更大。结论以0．05为界，T1或他时间点骨髓幼稚细胞比例是原发、初治AML患者（非M3型）CR率、RFS、总生存的独立预后因素。将染色体核型与T1和（或）T2时间点骨髓幼稚细胞比例相结合分组，可进一步区分中等组患者，有助于评估预后和选择治疗方案。

Objective To evaluate the impact of the percentage of residual blasts in bone marrow at the end of induction chemotherapy （ T1 ） or during myelosuppression phase （ T2 ） on prognosis of de novo acute myeloid leukemia（AML） （ non M3 ） in 105 cases. To refine AML risk-stratification by combining the percentage of residual blast cells （T1 or/and T2） with cytogenetic data based the South West Oncology Group （SWOG） criteria. Methods The data of 105 de novo AML （non M3） patients hospitalized between January 1st 1999 and February 1 st 2008 were retrospectively reviewed. Results were analyzed with SPSS15.0 software. Results （ 1 ） Patients were divided into two subgroups by a cutoff of 5% residual bone marrow blasts at T1 or T2 time point. Patients with percentage of residual bone marrow blast cells 〈 5% had better complete remission （CR） rate, relapse-free survival （RFS） and overall survival （OS） than the patients with percentage I〉5% at T1 or T2. The percentage of residual bone marrow blast cells at T1 was correlated with that at T2. （2） The prognosis of patients with intermediate karyotypes with percentage 〈 5 % at T1 or T2 was similar to that of the patients with favorable karyotypes. The patients with intermediate karyotypes and percentage of residual bone marrow blasts /〉5% at T1 or T2 are defined as a subgroup with prognosis similar to that of patients with unfavorable karyotypes. （3） COX regression analysis showed that the percentage of residual bone marrow blasts at T1 or T2 is an independent prognostic factor of AML. The percentage of residual bone marrow blasts at T1 may be more helpful in prognostification than that at T2. Conclusion AML patients with percentage of residual bone marrow blasts 〈 5% after induction chemotherapy （ T1 or T2） have better CR rate, RFS, OS than the patients with percentage ~5% at the same time point. Combination of cytogenetics and percentage of residual bone marrow blasts at T1 or T2 is helpful to divide patients with intermediate karyotypes into two subgroups with different prognosis. Thus, a better decision of treatment strategy can be designed.