急性白血病诱导化疗失败的原因分析

Study on induction failure in acute leukemia

目的 :了解急性白血病 (AL)患者的一般情况、疾病本身以及化疗方案等因素对诱导缓解的影响 ,分析诱导失败的原因。方法 :患者骨髓细胞采用RHG和G带法进行染色体检测 ;以流式细胞仪检测多药耐药 1(MDR 1)的表达。将 195例AL患者按诱导缓解成功与否进行分组 ,对患者的年龄、性别、FAB分型、症状、骨髓和外周血情况、染色体改变、血清乳酸脱氢酶 (LDH)以及化疗方案等一系列指标进行比较。结果 :142例在两次诱导化疗后完全缓解 (缓解组 ) ,5 3例未缓解 (难治组 )。与缓解组相比 ,难治组急性非淋巴细胞白血病 (ANLL)患者比例、浸润症状的发生率、外周血白细胞计数和血清LDH水平、除t(8;2 1)外的其他染色体异常所占比例显著升高。去甲氧柔红霉素治疗组患者的缓解率高于其他化疗方案。结论 :AL患者的分型、浸润情况。

Objective:To elucidate the main factors influencing the induction remission of adult acute leukemia (AL). Method:The age, sex, FAB type, clinical manifestation, bone marrow and peripheral blood cell counts, karyotype, serum lactate dehydrogenase (LDH) level and regimen of chemotherapy were analyzed in 195 cases of AL patients. Result:The patients were divided into two groups according to the remission status after two cycles of induction chemotherapy, referred as the remission group and the refractory group. Comparing with the remission group, the ratio of acute non-lymphocytic leukemia, the incidence of infiltration, peripheral white blood cell counts (WBC) and serum LDH greatly increased in the refractory group. Moreover, the chromosome abnormalities except t(8;21) was more frequent in the refractory group than that in the remission group. Inclusion of idarubicin showed great benefit as far as the remission rate was concerned.Conclusion:The FAB type, infiltration symptom, leukemic cell burden and its biological characteristics, as well as the chemotherapy regimens are important factors for induction failure.