老年人初治急性早幼粒细胞白血病的临床研究

Clinical study of elderly patients with acute promyelocytic leukemia

目的 探讨老年人初治急性早幼粒细胞白血病（APL）的临床特点、治疗及预后.方法 回顾性比较分析21例老年及89例中青年（＜60岁）初治APL患者的临床资料,并按白细胞（WBC）计数的不同进行老年人APL分组比较.结果 老年APL与中青年APL患者的性别（男女性别比11∶10对47∶42）、治疗前的WBC（高白细胞比例：23.8%比16.9%）、骨髓原始细胞＋早幼粒细胞（0.83±0.11对0.83±0.12）、诱导治疗的完全缓解（CR）率（71.4%对84.3%）、达CR的天数[（35.7±10.1）d对（39.1±13.5）d]、维甲酸综合征（RAS）发生率（14.3%对22.5%）、弥散性血管内凝血（DIC）发生率（52.4%对34.8%）及2年总生存率（72.7%对80.0%）差异均无统计学意义（P＞0.05）,老年APL患者诱导治疗过程中早期死亡率明显高于中青年APL患者（28.6%对11.2%）（P＜0.05）.21例接受诱导治疗的老年患者中,5例为高白细胞型,16例为非高白细胞型,高白细胞组老年APL患者的DIC和早期死亡发生率分别为80%、60%,高于非高白细胞组（43.8%、18.8%）,而CR率较低（40.0%对81.3%）.结论 老年及中青年APL患者均具有较好的预后,高白细胞型诱导治疗疗效低于非高白细胞型.

Objective To investigate the clinical features, therapy and prognosis of elderly patients with newly diagnosed acute promyelocytic leukemia （APL）. Methods The clinical features of 21 elderly patients and 89 patients aged 〈60 with newly diagnosed APL were retrospectively analyzed. Additionally,elderly patients were divided into different groups according to the count of white blood cell （WBC）. Results There were no significant differences between elderly patients and patients aged 〈60 in the aspect of sex （male/female： 11/10 vs 47/42）, WBC count （high initial WBC： 23.8 % vs 16.9 %）, the percentage of bone marrow blasts plus promyelocytes （0.83±0.11 vs 0.83±0.12）, complete remission （CR） rate （71.4 % vs 84.3 %）,the time of CR occurrence （35.7±10.1 vs 39.1±13.5）, the occurrence of retinoic acid syndrome（RAS） （14.3 % vs 22.5 %）, disseminated intravascular coagulation （DIC） （52.4 % vs 34.8 %） as well as 2 years overall survival rate （72.7 % vs 80.0 %） （P 〉0.05）. Of the 21 elderly patients who received inductive treatment, 5 with high initial WBC and 16 without high initial WBC. The incidences of DIC, early death in high initial WBC group were 80 %, 60 % respectively, which were higher than the group without high initial WBC （43.8 %,18.8 % respectively）, whereas CR rate for the group with high initial WBC （40.0 %） was lower than that for the group without high initial WBC （81.3 %）. Conclusion Elderly patients with APL could have fine prognosis as well as patients aged 〈60. The results of inductive treatment of elderly patients in high initial WBC group were poor as compared with the group without high initial WBC.