以亚砷酸为主的维持治疗下染色体核型对急性早幼粒细胞白血病患者预后的影响

Effect of Chromosomal Karyotype on the Prognosis of Patients with Acute Promyelocytic Leukemia in Condition of the Maintenance Treatment Based on Arsenic Trioxide

目的:探讨在以亚砷酸为主的维持治疗体系下染色体核型对急性早幼粒细胞白血病患者的预后影响。方法:回顾性收集12年内本院住院治疗的急性早幼粒细胞白血病患者,并选取其中以亚砷酸为主的方案维持治疗且可随访的患者,分为单纯t(15;17)组,t(15;17)伴有附加染色体异常组,正常核型组并探讨附加染色体异常对患者预后的影响,同时进一步探讨复杂核型对预后的意义。结果:单纯t(15;17)组患者共57例,早期死亡8例,其早期死亡率为14.0%。附加染色体异常组患者21例,其早期死亡4例,死亡率19.0%。正常染色体组15例,早期死亡5例,其死亡率33.3%,3组间早期死亡率无统计学差异。其余76例患者均达到完全血液学缓解。对76例患者进行长期随访,中位随访43.9个月,其中单纯t(15;17)组患者复发2例,复发率3.5%,附加染色体异常组患者复发1例,复发率4.2%,正常染色体组无病例复发。3组间总生存率、无病生存率无统计学差异。进一步分析显示,复杂染色体核型的患者无复发生存率较低,但总体生存率未显示显著区别。结论:以亚砷酸为主的维持治疗体系,附加染色体异常总体上不影响急性早幼粒细胞白血病患者的预后,但是复杂染色体核型可能会降低患者的无复发生存率。

Objective:To investigate the effect of chromosomal karyotype on the prognosis of patients with acute promyelocytic leukemia(APL)in condition of the maintenance treatment based on arsenic trioxide.Methods:The patients with acute promyelocytic leukemia for last 12 years in our hospital were retrospectively collected.The patients mainly treated with arsenic trioxide in maintenance protocol were selected and followed up.All the patients were divided into 3 groups according to cytogenetic data:single t(15;17)group,t(15;17)with additional chromosomal abnormality(ACA)group,and normal karyotype group.Then,the prognostic significance of ACAs and complex karyotype were investigated in APL patients.Results:There were 57 cases in the single t(15;17)group,in which 8 cases died in the first month after induction treatment with early mortality rate of 14%.There were 21 patients in t(15;17)with ACA group,in which 4 cases died in the first month with early mortality rate of 19%.There were 15 cases in normal chromosome group,in which 5 cases died in the first month with the early mortality rate of 33.3%.There was no statistical difference in the early mortality among 3 groups.All the remaining 76 patients achieved complete hematological remission.These patients were followed up.The median follow-up time was 43.9 months.Among them,only 2 patients in single t(15;17)group and 1 patient in t(15;17)with ACA group relapsed.No patient relapsed in normal karyotype group.The relapse rate was 3.5%in single t(15;17)group and 4.2%in t(15;17)with ACA group,respectively.There was no statistical difference in the overall survival and disease-free survival rates among 3 groups.Further analysis showed that the patients with complex chromosome karyotypes had lower relapse-free survival rates,but overall survival rates were not significantly different in 3 group.Conclusion:In general,ACA can not affect the prognosis of patients with acute promyelocytic leukemia in condition of the maintenance treatment based on arsenic trioxide,but the complex chromosomal karyotype may reduce the relapse-free survival rates.