老年急性单核细胞白血病个体化治疗及其预后分析

Prognosis and individual therapy analysis of elderly patients with acute monocyte leukemia

目的依据治疗方案及危险度分层,对老年急性单核细胞白血病(M5)患者预后进行综合评价,指导个体化治疗。方法回顾性分析79例年龄≥60岁初发M5患者的临床资料,其中65例患者接受诱导缓解治疗并评估疗效,依据治疗方案分为标准剂量化疗方案组、低强度化疗方案组,依据细胞遗传学或分子生物学指标分为低危、中危及高危组,分析其与临床预后的关系。结果 65例患者完全缓解(CR)率61. 5%(40/65),中位生存时间355 d,1年总生存(OS)率64. 0%,2年OS率为36. 5%,1年无病生存(DFS)率51. 2%,2年DFS率为14. 1%。标准剂量化疗方案组CR率为69. 2%(27/39),2年OS率为46. 4%、2年DFS率为11. 7%,与低强度化疗方案组的50%(13/26)、23. 3%、17. 5%,均差异无统计学意义(P> 0. 05),两组不良反应发生率相当(P> 0. 05)。低危组患者CR率87. 5%(14/16),中危组CR率61. 5%(16/26),高危组CR率43. 5%(10/23),差异无统计学意义(P> 0. 05)。此外,低危组1年OS率、1年DFS率,2年OS率,2年DFS率,均优于中危及高危组。危险度分层内标准剂量化疗方案组与低强度化疗方案组相比:中危患者前组2年OS率优于后组(P <0. 05),低危及高危患者两治疗组CR率、2年OS率及2年DFS率差异无统计学意义(P> 0. 05)。结论老年AML-M5患者中危组可从标准剂量化疗方案诱导化疗方案中受益,延长生存时间,低危组及高危组需结合患者综合情况制定个体化治疗方案。

Objective According to the therapy and risk stratification, the prognosis of elderly patients with a- cute monocytic leukemia （MS） was comprehensively evaluated to guide individual therapy. Methods A retrospective analysis of the clinical data of 79 elderly M5 patients aged over 60 years were analyzed, of which 65 patients received in- duced remission treatment and evaluated the curative effect. According to the treatment scheme, the routine close group and low intensity- chemotherapy group were divided into the cytogenetic or molecular biological indicators. They were di- vided into low risk group, middle risk group and high risk group, and their relationship with clinical prognosis was ana- lyzed. Results The total renfission （CR） rate of 65 patients was 61.5% （40/65） ,Median survival time of 355 days, the 1 year total survival （OS） rate was 64% ,the 2 year OS rate was 36.5% ,the 1 year disease free survival （DFS） rate was 51.2% ,and the 2 year DFS rate was 14.1%. In the routine close group,the CR rate was 69.2% （27/39） ,the 2 year OS rate was 46.4% , and the 2 year DFS rate was 11.7%. There were no significant differences （P 〉 0.05 ） with 50.0% （13/26） ,23.3% and 17.5% of the low intensity- chemotherapy group,The incidence of adverse reactions in the two groups was equal （ P 〉 0.05）. The CR rate of the low risk group was 87.5% （ 14/16）, the CR rate of the middle risk group was 61.5% （16/26） ,and the CR rate of the high-risk group was 33.5% （10/23）,and the difference was not statistically significant （P 〉0.05）. The 1 year OS rate in low risk and middle risk group was 81.2% ,75.3% and 38 % , 2 year OS rate 74.5 % , 32.2 % ,7.61% , 1 year DFS rate 81.2 % ,49.2 % , 32.6 % ,2 years DFS rate 43.8 % , low- er risk group （ P 〈 0. 05）. Compared with the low intensity chemotherapy group,the 2 year OS rate and the 2 year DFS rate in the middle risk group were better than those in the latter group, and there was no significant difference between the low risk group and the middle risk group. Conclusion The elderly AML-M5 patients of middle risk group can bene- fit from the routine dose induced chemotherapy regimen with prolonged the survival time, and the low risk group and the high risk group should combine the general condition to guide individual therapy.