老年人初发急性髓系白血病治疗效果评价

Efficacy evaluation of primary acute myeloid leukemia in the elderly patients

目的 分析老年人急性髓系白血病（AML）患者临床治疗效果. 方法 回顾性分析我院自2009年1月至2013年12月老年（年龄≥60岁）初发AML（非急性早幼粒细胞白血病）患者272例临床资料,对有生存资料的186例患者诱导缓解治疗和缓解后巩固治疗疗效进行分析. 结果 （1）采用诱导缓解治疗组中位生存期优于保守治疗组（10个月比3个月）,差异有统计学意义（x2=25.47,P=0.00）;（2）不同诱导缓解方案临床完全缓解率、总有效率、早期病死率比较,差异均无统计学意义（均P＞0.05）;（3）缓解后采用巩固治疗患者优于没有采用巩固治疗患者,中位生存期分别为15个月和6个月（x2 =5.12,P=0.02）;采用4～6个疗程巩固治疗生存期优于1～3个疗程,中位生存期分别为39个月和11个月,差异有统计学意义（x2 =7.72,P=0.01）;复发率分别为50.0％和33.3％,差异无统计学意义（x2=0.81,P=0.37）. 结论 对于一般情况较好、无严重脏器功能损害的老年AML患者,采用积极的治疗方法可提高疗效,延长生存期.

Objective To evaluate the efficacy of primary acute myeloid leukemia （AML） in the elderly patients.Methods Clinical treatment of 272 elderly patients （aged 60 years and over） with primary AML （non acute promyelocytic leukemia） in our hospital from January 2009 to December 2013 were analyzed retrospectively.Survival data of remission induction and post-remission treatment in the 186 patients were analyzed.Results （1） The median survival time in the patients with remission induction chemotherapy was superior to that in the patients with conservative treatment （10 months vs.3 months,x2 =25.47,P=0.00）.（2）The complete remission rate,overall response rate and early death rate had no significant differences among the patients with different remission induction chemotherapy （all P＞0.05）.（3）The efficacy in patients with post-remission treatment was better than that in those without post-remission treatment,and their median survival time were 15 months versus 6 months （x2 =5.12,P=0.02）.The survival time in patients with 4-6 courses of postremission treatment was better than that in patients with 1-3 courses of post-remission treatment,and their median survival time were 39 months versus 11 months respectively （x2 =7.72,P=0.01）,but the recurrence rate was 50.0％ and 33.3 ％ respectively （x2 =0.81,P=0.37）.Conclusions For elderly patients with AML in good physical condition and without severe dysfunction of major organs,positive treatment can improve the efficacy and prolong the survival time.