骨髓增生异常综合征患者淋巴细胞绝对值计数与地西他滨治疗反应的关系

The absolute value of lymphocyte counts and the response to decitabine treatment in patients with myelodysplastic syndrome

目的探计第1疗程地西他滨(DAC)治疗后骨髓增生异常综合征(MDS)患者淋巴细胞计数与患者对DAC治疗反应的关系。方法研究对象为2014年1月-2016年12月在河北大学附属医院血液科接受过DAC治疗的MDS和MDS继发的急性髓系白血病(AML)患者35例。根据第1个疗程DAC治疗后28~35d血常规中的淋巴细胞计数,将患者分为高淋巴细胞组(H-Lym组,淋巴细胞计数≥1.2×10~9/L)和低淋巴细胞组(L-Lym组,淋巴细胞计数<1.2×10~9/L)。采用Pearsonχ2检验分析两组患者基线资料的差异,采用t检验分析两组患者第1疗程DAC治疗前后淋巴细胞计数的变化,采用Kaplan-Meier法绘制无进展生存期(PFS)曲线并进行log-rank检验对两组累积生存率进行比较。结果 35例患者中H-Lym组15例,L-Lym组20例,两组基线淋巴细胞水平差异无统计学意义(P>0.05),两组基线资料中仅骨髓原始细胞≥10%的患者比例的差异有统计学意义(P<0.05)。H-Lym组患者在第1疗程DAC治疗后淋巴细胞计数较诊断时升高,但差异无统计学意义(P>0.05),而L-Lym组则明显低于诊断时的水平(P<0.05)。H-Lym组总反应率(80.0%)明显高于L-Lym组(40.0%),差异有统计学意义(P<0.05)。H-Lym组的中位PFS为10个月,L-Lym组为7.6个月,两组差异有统计学意义(P<0.05)。单因素分析结果显示,淋巴细胞计数绝对值低是MDS疾病进展的预后因素(P<0.05)。结论第1疗程DAC治疗后淋巴细胞计数≥1.2×10~9/L的患者具有较高的总反应率和较长的无进展生存期。

Objective To investigate the relations of absolute lymphocyte counts（ALC） to the therapeutic responses in patients with myelodysplastic syndrome（MDS） after the first course of decitabine（DAC） treatment. Methods Clinical data of 35 patients with MDS and MDS-derived secondary acute myeloid leukemia（AML） who were admitted in the Affiliated Hospital of Hebei University from Jan. 2014 to Dec. 2016 and treated with DAC were included in the present study. The patients were grouped into high lymphocyte group（H-Lym, ALC ≥1.2×10~9/L） and low lymphocyte group（L-Lym, ALC1.2×10~9/L） based on the ALC in days 28-35 after the first course of DAC treatment. The baseline data of both groups were compared with Pearson χ2 analysis, while t test was used to analyze the changes of lymphocyte number before and after the first course of DAC treatment. Progressionfree survival（PFS） was estimated with Kaplan-Meier method, and the cumulative survival（CS） was compared between the two groups using log-rank test. Results Of the 35 patients, 15 were in H-Lym group and 20 in L-Lym group. No significant difference existed in the baseline lymphocyte levels between the two groups（P0.05）. The statistically significant differences（P0.05） existed only in the patients of the two groups who were with the proportion of bone marrow blasts ≥10%. The ALC in H-Lym group were slightly higher after the first course of DAC treatment than that at the time of diagnosis, but with no statistically significant（P0.05）. However, the ALC in L-Lym group were significantly lower after the first course of DAC treatment than that at the time of diagnosis（P0.05）. Patients had higher overall response rate（ORR） in H-Lym group than in L-Lym group（80% vs. 40%, P0.05）. The median PFS was 10 months in H-Lym group and 7.6 months in L-Lym group（P0.05）. Univariate analysis showed that the low ALC was a poor prognostic factor for the progression of MDS（P0.05）. Conclusion Patients with ALC ≥1.2×10~9/L after the first course of DAC treatment will have better ORR and longer PFS.