急性早幼粒细胞白血病217例长期生存因素分析

Analysis of Factors on Long-term Survival in 217 Cases of Acute Promyelocytic Leukemia

目的探讨影响急性早幼粒细胞白血病(APL)患者长期生存的主要因素,为改善预后、延长患者生存期提供临床依据。方法对1978-1989年和1990-2003年分别收治的99例、118例初发APL患者的资料进行回顾性队列研究和生存分析。结果217例APL患者中72例患者达到5年以上长期生存。1978-1989年与1990-2003年患者5年总体生存率分别为4.0%和56.0%,完全缓解(CR)及CR后长期生存率分别为56.6%和89.0%、7.1%和64.8%。年龄、白细胞、血小板、骨髓异常早幼粒细胞、免疫表型、染色体核型、诱导方案、达CR1时间、CR后治疗时间是影响长期生存的重要预后因素;性别、发热、出血、肝脾淋巴结肿大、血清铁蛋白、乳酸脱氢酶对长期生存无影响。结论骨髓异常早幼粒细胞>70%、达CR1时间>30 d、CD34阳性表型、非典型染色体核型者是不利于长期生存的独立危险因素;血小板≥30.0×109/L、使用ATRA+CH诱导方案、CR后治疗时间≥3年则有利于长期生存。

Objective To investigate the main factors about acute promyelocytic leukemia in patients with long-term survival in order to improve the prognosis of patients, to prolonge the survival time based on the clinical approaches. Methods Ninety-nine and 118 newly diagnosed patients with APL for 1978-1989 and 1990-2003 admitted respectively to Department of Hematology who were investigated with retrospective cohort and survival analysis. Results Seventytwo of 217 patients with APL achieved more than 5 years long-term survival. Five-year overall survival（OS） rates of 1978-1989 and 1990-2003 were 4.0% and 56.0% respectively. CR rates of 1978-1989 and 1990-2003 were 56.6% and 89.0%,5-year long-term survival rates of post- CR were 7. 1% and 64.8% respectively. Age, number of WBC, number of PLT, proportion of bone marrow abnormal promyetocyte cell, immunophenotype, karyotype, induction-program, time to CR1, time of post-CR therapy all were important prognostic for long-term survival. Gender, fever,bleeding,lymphadenectasis and hepatosplenomegaly, SF and LDH were not associated with long-term survival. Conclusion The proportion of bone marrow abnormal promyelocyte cells〉 70 %, time to CR1〉30 days, CD34 positive immunophenotype, the non-typical karyotype, were independent risk factors to long-term survival. Number of PLT≥30.0× 10^9/L, ATRA-t-CH induc tion-program,time of post-CR therapy ≥3 years were favorable factors of long-term survival.