不同血小板数量分层在儿童初治原发急性髓系白血病中的临床意义

Clinical significance of different stratification of platelet count in primary acute myeloid leukemia in children

目的分析不同血小板数量分层儿童初治原发急性髓系白血病(AML)(非M3型)的临床特点。方法回顾性分析2014年1月至2018年12月郑州大学附属肿瘤医院247例儿童初治原发非M3型AML患者的实验室和临床资料,根据患儿治疗前血小板计数(PLT),以<50×10^(9)/L,≥50×10^(9)/L且<125×109/L和≥125×10^(9)/L为界限,分为血小板极低组(VLG)、低组(LG)和不减低组(NLG),所有入选患儿随访至2019年6月30日,随访数据通过查阅病历或打电话获取。应用SPSS 17.0软件进行数据分析。结果血红蛋白(Hb)含量不同分组、融合基因AML-ETO和临床危险度分层在不同PLT分组中的差异均有统计学意义(χ^(2)=11.270、12.115、12.848,均P<0.05),其他指标在PLT不同分组中的差异均无统计学意义(均P>0.05)。3组患儿的无病生存(DFS)率分别为59.3%、36.3%和50.4%,差异均无统计学意义(均P>0.05);NLG患者中位OS时间(40.5个月)、3年OS率(41.0%)明显高于VLG(23.1个月、30.1%)和LG患儿(14.1个月、18.2%),差异均有统计学意义(χ^(2)=7.798、6.553,均P<0.05)。对患者性别、白细胞(WBC)、HGB、PLT、乳酸脱氢酶(LDH)、FLT3-ITD、NPM1、DNMT3A、CEPBA、C-KIT、AML-ETO、分子遗传学预后、完全缓解(CR)和造血干细胞移植(HSCT)等因素进行单因素分析,DNMT3A突变是影响患儿OS的不良因素(χ^(2)=5.834,P<0.05),治疗前PLT不减低、获得CR和后续行HSCT为影响OS的积极因素(χ^(2)=7.798、79.168、31.337,均P<0.05)。多因素分析,治疗前PLT不减低、获得CR和后续行HSCT是影响患儿OS的独立保护因素(Wald=42.760、15.918、10.183,均P<0.05)。结论治疗前PLT不减低是初治原发儿童AML的保护性因素,预后良好。

Objective To analyze the clinical characteristics of primary acute myeloid leukemia(AML)(non-M3 type)in children suffering from different levels of platelet count(PLT).Methods In the Tumor Hospital of Zhengzhou University from January 2014 to December 2018,laboratory and clinical data of 247 de novo primary AML pediatric patients were retrospectively reviewed.According to the PLT before treatment,patients were divided into very low platelet group(VLG),low platelet group(LG)and non-lowing platelet group(NLG),with<50×10^(9)/L,≥50×109/L but<125×10^(9)/L and≥125×10^(9)/L as the boundaries.All patients were followed up until June 30,2019.Meanwhile,the follow-up data was obtained by consulting medical records or by telephone.SPSS 17.0 software was applied for data analysis.Results In general clinical features,a different group of hemoglobin(Hb)content,fusion gene AML-ETO and clinical risk stratification were statistically significant in different PLT groups(χ^(2)=11.270,12.115 and 12.848,respectively,all P<0.05).However,the differences of other indicators in different groups of PLT were not statistically significant(all P>0.05).There were no statistically significant differences in terms of 3-year disease-free survival(DFS)rate(59.3%,36.3%,50.4%)among the 3 groups(all P>0.05).The median total survival(OS)time(40.5 months)and 3-year OS rate(41.0%)of NLG patients were significantly higher than those of VLG(23.1 months,30.1%)and LG(14.1 months,18.2%)patients,with statistically significant differences(χ^(2)=7.798 and 6.553,respectively,all P<0.05).The univariate analysis of gender,white blood cell(WBC),Hb,PLT,lactic dehydrogenase(LDH),FLT3-ITD,NPM1,DNMT3A,CEPBA,C-KIT,AML-ETO,molecular genetic prognosis,complete remission(CR),and hemopoietic stem cell transplantation(HSCT)displayed that DNMT3A mutation was an adverse factor that affects patients′OS(χ^(2)=5.834,P<0.05),and the positive factors that influences OS were non-reducing PLT before treatment,and obtaining CR and subsequent HSCT(χ^(2)=7.798,79.168,and 31.337,respectively,all P<0.05).Multi-factor analysis revealed that the independent protective factors that affect patients′OS were the non-reducing PLT before treatment,and obtaining CR and subsequent HSCT(Wald=42.760,15.918,and 10.183,respectively,all P<0.05).Conclusions Before treatment,non-reducing PLT is a protective factor for primary childhood AML patients,and the prognosis is satisfying.