高WBC的初治原发AML患者临床特征分析

Analysis on clinical features of initially treated primary AML patients with high WBC

目的分析外周血白细胞(WBC)大于或等于100×109/L的初治原发急性髓系白血病(AML)患者临床特征。方法回顾性分析2015年1月至2016年12月该院血液科144例初治原发AML住院患者的临床资料,男76例,女68例,中位年龄41.5岁,年龄四分位间距为25.25～53.75岁,以100×109/L为临界值,把初治原发AML患者按血常规WBC的不同分为血常规WBC<100×109/L(NHL-AML)组和血常规WBC≥100×109/L(HL-AML)组。根据临床特征数据的类型,分别采用t检验、秩和检验或χ2检验比较各组临床特征的差异。结果 HL-AML组19例,NHL-AML组125例。HL-AML组预后良好患者比例低于NHL-AML组,差异有统计学意义(χ2=7.098,P<0.05);HL-AML组患者AML-M5亚型、单体核型、FLT3-ITD和NPM1基因突变所占比例高于NHL-AML组,差异有统计学意义(χ2=4.125、5.534、19.706、7.058,P<0.05)。结论与NHL-AML初治原发AML患者相比,HL-AML患者多为WHO急性髓系白血病分型中AML非特定类型中的M5型,常见单体核型,易伴FLT3-ITD和NPM1基因突变。

Objective To analyze the clinical features of initially treated primary acute myeloid leukemia(AML)patients with peripheral blood WBC≥100×10^9/L.Methods The clinical data in 144 cases of initially treated primary AML in the hematology department of this hospital from January 2015 to December 2016 were retrospectively analyzed,including 76 males and 68 females,the median age was 41.5 years old,the age interquartile interval was 25.25-53.75 years old.With 100×10^9/L as the critical value,the initially treated primary AML patients were divided into the blood routine WBC<100×10^9/L group(NHL-AML)and the blood routine WBC≥100×10^9/L group(HL-AML).According to the types of clinical characteristics data,the differences of clinical features were compared between different groups by adopting the t test,chi-square test or rank sum test.Results There were 19 cases in the HL-AML group and 125 cases in the NHL AML group.The proportion of the patients with good prognosis in the HL-AML group was lower than that in the NHL-AML group,and the difference was statistically significant(χ^2=7.098,P<0.05).The proportion of AML-M5 subtype,monosomal karyotype,FLT3-ITD and NPM1 gene mutations in the HL-AML group was higher than that in the NHL-AML group,the difference was statistically significant(χ^2=4.125,5.534,19.706,7.058,P<0.05).Conclusion Compared with initially treated primary AML patients with NHL-AML,the patients with HL-AML are mainly M5 type in non-specific types of AML by WHO acute myeloid leukemia classification,monosomal karyotype is common,which is easily accompanied by FLT3-ITD and NPM1 gene mutations.