中高危骨髓增生异常综合征转化为急性髓系白血病的高危因素

High Risk Factors for Transformation into Acute myeloid Leukemia in Patients with Intermediate and High Risk Myelodysplastic syndrome

目的:探讨以地西他滨为主治疗中高危骨髓增生异常综合征(MDS)患者转化为急性髓系白血病(AML)的高危因素。方法:回顾性分析60例中高危MDS患者的临床特点及其转化为AML的高危因素。结果:以地西他滨为主治疗的中高危MDS患者总有效率(ORR)为65.0%(39/60),其中达完全缓解(CR)患者17例(28.3%),骨髓缓解(m CR)患者5例(8.3%);部分缓解(PR)患者4例(6.7%);血液学缓解(HI)患者13例(21.7%)。60例以地西他滨为主治疗的中高危MDS患者转化为AML 21例(35.0%),中位转化时间为10.0(1.5月-32.0)个月。χ^2或Fisher精确检验显示,中高危MDS转化为AML与2016年WHO诊断分型、骨髓增生明显活跃、地西他滨用药间隔延长相关(χ^2=9.878,P=0.031;χ^2=4.319,P=0.038;χ^2=6.406,P=0.011);Kaplan-Meier检验单因素分析显示,中高危MDS转化为AML与2016年WHO诊断分型、骨髓原始细胞数、骨髓病态造血系数、地西他滨疗程间隔延长相关(P=0.015,P=0.008,P=0.012,P=0.032);COX多因素分析显示,骨髓原始细胞数、骨髓病态造血系数为中高危MDS患者转化为AML的独立危险因素(P=0.022,P=0.018)。结论:骨髓原始细胞数、骨髓病态造血系数是以地西他滨为主治疗中高危MDS患者转化为AML的独立危险因素;地西他滨用药间隔规律有利于维持病情稳定。

Objective:To study the high risk factors for the transformation into acute myeloid leukemia(AML)in patients with intermediate and high risk myelodysplastic syndrome(MDS)treated by decitabine-based regimen.Methods:The clinical characterstics of 60 intermediate and high risk MDS patients and the factors of its transformed into AML were retrospectively analyzed.Results:The overall response rate(ORR)of the patients suffered from intermediate and high risk MDS treated by decitabine-based regimen was 65.0%(39/60),among the 60 cases 17 achieved complete remission(CR),5 achieved morrow complete remission(mCR),4 achieved partial remission(PR)and 13 achieved hematologic improvement(HI).Twenty-one cases(35.0%)were transformed into AML among 60 cases of intermediate and high risk MDS treated by decitabine-based regimen.The median time of transformation from intermediate and high risk MDS into AML was 10.0 months(1.6-32.0).χ^2 or Fisher’s exact test showed that 2016 WHO MDS diagnostic subgrouping,myeloid hyperplasia markedly active,delayed interval of decitabine-based treatment associated with the transformation from intermediate to high risk MDS into AML(χ^2=9.878,P=0.031;χ^2=4.319,P=0.038;χ^2=6.406,P=0.011);Univariate analysis of Kaplan-Meier test showed that 2016 WHO MDS diagnostic subgroups,bone marrow blast cell ratio,bone marrow dysplasia coefficients,prolonged interval of decitabine-based treatment associated with the transformation from intermediate and high risk MDS into AML(P=0.015,P=0.008,P=0.012,P=0.032);multivariate analysis showed the bone marrow blast cell ratio and the bone marrow dysplasia coefficients were independent risk factors for the transformation from intermediate to high risk MDS into AML(P=0.022,P=0.018).Conclusion:The bone marrow blast cell ratio and the bone marrow dysplasia coefficients are independent risk factors of transformation into AML in the patients with intermediate and high risk MDS treated by decitabine-based regimen.The regular interval of dicitabine treatment is beneficial to maintain the stability of patients conditions.