骨髓增生异常综合征转化为急性白血病的高危因素分析

Study on high-risk factors affecting the evolution from myelodysplastic syndrome to acute leukemia

目的:探讨影响骨髓增生异常综合征(MDS)转化为急性白血病的高危因素。方法:回顾性分析我院收治的101例MDS患者的转白时间、转白亚型、临床特征、实验室数据等临床资料。结果:101例MDS患者中,34.6%(35/101)转化为急性髓系白血病,中位转白时间7.5(0.5~53)个月,中位生存时间40.7(1~87)个月。单因素分析发现,染色体核型、骨髓原始细胞比例、血细胞减少系数、病态造血累及系数、WHO分型均影响MDS患者的转白率(均P<0.05)。多因素分析发现,染色体核型、病态造血系数、WHO分型是MDS向急性白血病转化的独立危险因素(均P<0.05)。转白组患者较未转白组患者的生存期明显缩短(11个月∶45个月)。结论:MDS是一类高风险向急性白血病转化的疾病,根据相关高危因素,对其进行预后评估,从而为个体化治疗提供临床依据,对延长患者转白时间及总生存时间具有重要意义。

Objective：To investigate factors affecting the evolution to acute leukemia of patients with myelodysplastic syndrome（MDS）.Method：Time to leukemic transformation,subtypes of leukemia transformations,clinical manifestation and laboratory parameters were retrospectively analyzed in 101 MDS patients.Result：Thirty-five cases transformed to acute myeloid leukemia in 101 MDS patients,the median evolution time was 7.5（0.5to 53）months,the median survival time was 40.7（1to 87）months.Single factor analysis showed that karyotype,marrow blast,number and extent of cytopenias,pathological hematopoiesis and WHO subtypes all could affect the rate of MDS evolution to acute leukemia（P〈0.05）.Multivariate analysis by Cox model showed that WHO subtypes,karyotype and pathological hematopoiesis were independent risk factors affecting the evolution from MDS to acute leukemia（P〈0.05）.Conclusion：MDS is one type of disease at high risk of transforming to leukemia.According to analyzing the related factors,we can provide clinical evidence for individualized treatment stratification,and prolong the survival time and the evolution time significantly.