急性早幼粒细胞白血病长期生存相关因素分析

Analysis of long-term survival related elements in acute promyelocytic leukemia

目的研究影响急性早幼粒细胞白血病（APL）长期生存的相关因素。方法回顾性分析62例APL的临床资料，应用Log—Rank检验和COX回归模型对62例患者的性别、年龄、初诊时白细胞计数、初诊时血小板计数、初诊时血清乳酸脱氢酶水平、诱导缓解方案、获得缓解所需时间、缓解后治疗方案进行单因素和多因素分析。结果62例患者中位随访31（6～102）个月，5年预计总体生存率（OS）为（77．1±6．2）％，5年预计无复发率（RFS）为（71．4±3．68）％。单因素分析显示，初诊时白细胞计数、诱导缓解方案、获得缓解所需时间、缓解后治疗方案是影响APL患者长期生存的主要因素；多因素分析显示，初诊时白细胞计数、缓解后治疗方案是影响APL患者长期生存的独立因素。结论APL患者获得完全缓解后，应用全反式维甲酸（ATRA）＋三氧化二砷（As2O3）＋化疗的序贯治疗方案将显著延长患者的生存时间。

Objective To investigate various factors influencing long-term survival of the patients with APL. Methods The clinical data of 62 cases with APL were analyzed retrospectively. Univariate and multivariate analysis of the potential factors influencing survival and prognosis were carried out with Log-Rank and Cox regression method, including sex, age, initial WBC count, initial Pit count, the level of LDH,first induction regimen, length from induction therapy to CR, and post-remission therapy. Results 62 cases were followed up for 6 to 102 months. 5-year OS and relapse-free survival （RFS） were （77.1±6.2）% and （71.4± 3.68）%, respectively.Univariate analysis revealed that initial WBC count, first induction regimen, length from induction therapy to CR and post-remission therapy were important prognostic factors for long-term survival. Multivariate analysis demonstrated that initial WBC count and post-remission therapy were associated with RFS and OS. Conclusion The post-remission therapy combining ATRA, As2O3 and chemotherapy would significantly improve the long-term survival of APL patients entering CR.