t(8;21)急性髓系白血病的临床特征及预后分析

Clinical features and prognostic factors of acute myeloid leukemia with t(8;21)

目的:观察t(8;21)急性髓系白血病(AML)的临床特征并分析影响预后的因素。方法:回顾性分析郑州大学第一附属医院68例初治成人t(8;21)AML患者的血常规、骨髓细胞形态学、免疫表型、细胞遗传学、疗效及生存状况,分析影响总体生存(OS)、无复发生存(RFS)的因素。结果:68例t(8;21)AML按FAB分型1例为M1型,1例为M4型,66例为M2型。单纯t(8;21)AML病例占38.2%(26/68),伴附加染色体异常病例占61.8%(42/68),主要为伴性染色体(-Y或-X)缺失。59例行流式细胞术检测,CD34阳性率93.2%,CD19阳性率54.2%,CD56阳性率79.7%,CD34CD19共表达者占54.2%。总体完全缓解(CR)率为94.1%(64/68),1个疗程CR率为73.5%(50/68)。64例可统计生存的患者3 a OS率为44.8%,3 a RFS率为47.9%。白细胞指数、染色体核型、中大剂量Ara-C疗程数对OS有影响(P<0.05)。结论:白细胞指数、染色体核型、中大剂量Ara-C疗程数是影响t(8;21)AML预后的主要因素。

Aim： To investigate the clinical features and the prognostic factors of acute myeloid leukemia（ AML） with t（ 8; 21）. Methods： A total of 68 AML patients with t（ 8; 21） in the First Affiliated Hospital of Zhengzhou University were retrospectively analyzed,including white blood cell index,marrow morphology,immunophenotype,chromosome karyotype,therapeutic effects,as well as the overall survival（ OS） and relapse free survival（ RFS）. The prognostic factors were analyzed. Results： According to FAB classification,there were 66 cases of M2,1 case of M1,and 1 case of M4. Cytogenetically,38. 2%（ 26/68） were simply t（ 8; 21）,while 61. 8%（ 42/68） were accompanied with additional chromosomal abnormalities,mainly loss of sex chromosome（- Y or- X）. Out of all the 59 cases with flow cytometry results,the positive rate of CD34 according to immunophenotype analysis was 93. 2%,that of CD19 was 54. 2%,that of CD56 was 79. 7%,and that of CD34CD19 was 54. 2%. The overall complete remission（ CR） rate was 94. 1%（ 64/68）,CR rate after the first course was 73. 5%（ 50/68）. The 3 year OS rate was 44. 8% and 3 year FRS rate was 47. 9%. White blood cell index,chromosome karyotype,intermediate/high dose cytarabine（ IDAC） courses were influencing factors for OS（ P〈0. 05）. Conclusion： White blood cell index,chromosome karyotype,IDAC courses are important prognostic influencing factors for AML with t（ 8; 21）.