急性髓细胞白血病早期病死高危因素及高白细胞髓性白血病首次化疗策略探讨

A study on risk factors of early death in patients with acute myelogenous leukemia and initial chemotherapy for hyperleukocytic acute myelogenous leukemia

目的 :探讨急性髓细胞白血病 (acutemyelogenousleukemia ,AML)早期病死 (earlydeath ,ED)的高危因素以及高白细胞髓性白血病 (hyperleukocyticacutemyelogenousleukemia ,HAML)的首次化疗策略。 方法 :采用回顾性病例对照、多因素分析的方法对 30 1例AML、31例HAML进行研究。结果 :白细胞计数 (≥ 10 0× 10 9/L)、骨髓增生度 (极度活跃 )、体温 (≥ 39℃ )、血小板计数 (≤ 2 0× 10 9/L)及白血病类型 (M5)等指标进入Logistic多元回归方程 (P =0 0 0 0 0 ) ,OR值分别约 5 0、4 9、3 3、3 2和 2 2 ;HAML的首次化疗 ,采用常规剂量 (平均相对剂量强度≥ 0 5 )、含蒽环类方案 (DA)化疗发生ED的危险性分别为小剂量 (平均相对剂量强度 <0 5 )、其它方案 (HA或HOAP)化疗的 12倍 (P =0 0 34 6 )和 7 5倍 (P =0 0 479)。结论 :白细胞计数 (≥ 10 0× 10 9/L)、骨髓增生度 (极度活跃 )、体温 (≥ 39℃ )、血小板计数 (≤ 2 0× 10 9/L)及白血病类型 (M5)等 5个指标为AMLED的高危因素 ,其中以HAML最为重要 ,而HAML首次化疗 ,采用小剂量、非蒽环类方案化疗 ,可能有助于降低ED率。

Objective: To investigate the risk factors of early death (ED) for patients with acute myelogenous leukemia (AML) The therapy strategy for hyperleukocytic acute myelogenous leukemia (HAML) was also discussed Methods: 301 cases of AML and 31 cases of HAML were studied, with retrospective analysis, control study, multi factors logistic regression analysis Results: Five factors including leukocytecount (≥100×10 9/L), marrow cellularity (hypercellularity), body temperature (≥39℃), blood platelet count(≤20×10 9/L) and subtype of acute leukemia(M 5) enter the logistic regression equation(P=0 0000) The OR values were 5 0, 4 9, 3 3, 3 2, and 2 2, respectively The initial chemotherapy of HAML with conventional dose (average relative dose intensity, ARDI≥0 5) or regiments including anthracycline antibiotics (DA), the relative risk of ED were about 12(P=0 0346) and 7 5 (P=0 0479) times as more as that with low dose chemotherapy (ARDI< 0 5) or non anthracycline antibiotics regiments (HA or HOAP) Conclusions:Five factors including leukocyte count (≥100×10 9/L),marrow cellularity (hypercellularity),body temperature (≥39℃),blood platelet count(≤20×10 9/L) and subtype of acute leukemia(M 5) are the risk factors influenced ED, and the HAML is the most important To the initial chemotherapy of HAML, treatment with low dose and no anthracycline antibiotics regiments may decreast ED rate