伴8号染色体异常急性单核细胞白血病临床特征与预后分析

Clinical features and prognosis of acute monocytic leukemia with abnormality of chromosome 8

目的探讨8号染色体异常急性单核细胞白血病(acute monocytic leukemia, AML-M5)的临床特征和预后。方法回顾性分析2016年1月至2018年1月浙江大学医学院附属第一医院143例初发AML-M5患者的临床资料及预后特征,并分析影响预后的因素。结果 143例初治AML-M5患者中,37例伴8号染色体核型异常[其中t(8;21)占6.99%(10/143),8号三体占16.08%(23/143),其他8号异常占2.80%(4/143)],73例核型正常,33例为其他非8号染色体异常。3组患者年龄、性别、血常规、骨髓细胞比例方面,无明显差异(P>0.05),而伴8号染色体异常组倾向于低白细胞(P<0.05)。131例接受化疗的患者,第一个疗程化疗缓解率为63.36%(83/131),1年生存率61.1%。单因素分析提示,年龄、第一次诱导化疗后缓解情况(是否缓解)、8号三体核型、治疗方式(是否联合造血干细胞移植)对预后有影响(P<0.05)。多因素分析提示,影响预后的独立危险因素包括年龄≥60岁(HR=2.134,95%CI 1.204~3.784,P<0.05)和确诊后第一次化疗缓解(HR=0.408,95%CI 0.227~0.733,P<0.05)。结论 8号染色体为AML-M5患者易受累的染色体,累及该染色体的患者初诊白细胞比较低,预后不良。化疗缓解后行异基因造血干细胞移植有利于延长生存期。

Objective To investigate the clinical characteristics and prognosis of patients with acute monocytic leukemia(AML-M5)with abnormality of chromosome 8.Methods The clinical features of 143 patients with AML-M5 were analyzed retrospectively,and the prognosis factors were analyzed.Results Out of 143 AML-M5 newly diagnosed patients,37 cases with chromosome 8 aberrations including t(8;21)accounting for 6.99%(10/143),trisomy 8 16.08%(23/143),and other 8 aberrations 2.80%(4/143);73 cases had normal karyotype,and 33 cases possessed non chromosome 8 abnormality.Statistically significant differences did not exist among age,sex,hemogram and bone marrow blasts(P>0.05).However,with chromosome 8 abnormality were predisposed to lower initial white blood cell count(P<0.05).Among 131 patients of receiving chemotherapy,the remission rate after the first course of inducible chemotherapy was 63.36%(83/131)and the one-year survival rate was 61.1%.Analysis of prognostic factors showed that age,the remission after the first induction of chemotherapy(complete remission or no remission),trisomy 8 chromosomal karyotype and treatment regimen(chemotherapy alone or plus hematopoietic stem cell transplantation) had effects on overall survival(P<0.05).Multivariate analysis revealed two independent risk factors:age≥60 years(P<0.05,HR=2.134,95% CI 1.204~3.784)and the complete remission after the first induction of chemotherapy(P<0.05,HR=0.408,95% CI 0.227~0.733).Conclusion Chromosome 8 is easily involved in AML-M5.The patients with involvement of this aberration have lower initial white blood cell count and a poor prognosis.Patients after complete remission have hematopoietic stem cell transplantation is beneficial to prolong survival.