急性髓系白血病诱导化疗后外周血淋巴细胞和单核细胞比值与疗效及预后的关系

Correlation of peripheral blood lymphocyte-to-monocyte ratio after induction chemotherapy with treatment efficacy and prognosis in acute myeloid leukemia

目的探讨初治急性髓系白血病(AML)患者诱导化疗后外周血淋巴细胞和单核细胞比值(LMR)在疗效评估及预后判断中的价值。方法回顾性分析山东省菏泽市立医院2015年1月至2020年1月收治的诱导化疗后1周血涂片初步镜检未见白血病细胞的初治AML(非急性早幼粒细胞白血病)患者的临床资料。应用受试者工作特征(ROC)曲线确定完成全部诱导化疗后1周LMR预测患者完全缓解(CR)的最佳临界值,并依据此值将患者分为低LMR组(LMR<最佳临界值)和高LMR组(LMR≥最佳临界值),比较两组患者临床特征和实验室检测指标的差异及两组疗效、复发及生存情况。结果63例患者入组。完成全部诱导化疗后1周中位LMR为3.64(0.13~88.01),诱导化疗1个疗程后达CR 51例(81.0%),2个疗程后达CR 54例(85.7%),最终CR患者56例(88.9%)。经ROC曲线分析,确定LMR最佳临界值为1.515。低LMR组和高LMR组分别有20例和43例。两组间年龄、性别、血红蛋白、骨髓原始细胞比例、白细胞计数、血小板计数、乳酸脱氢酶水平差异均无统计学意义(均P>0.05)。低LMR组和高LMR组1个疗程后CR率分别为65.0%(13/20)、88.4%(38/43),差异有统计学意义(χ^(2)=4.836,P=0.028)。低LMR组1个疗程达CR的13例患者中复发3例,高LMR组1个疗程达CR的38例患者中复发2例;低LMR组和高LMR组两组3年RFS率分别为64%、80%,差异无统计学意义(χ^(2)=2.897,P=0.089);3年OS率分别为84%、80%,差异无统计学意义(χ^(2)=0.136,P=0.712)。结论对于完成诱导化疗后1周血涂片镜检未见有核细胞的初治AML患者,LMR可能用于评估疗效和复发情况。

Objective To explore the value of peripheral blood lymphocyte-to-monocyte ratio(LMR)after induction chemotherapy in patients with acute myeloid leukemia(AML)for the judgment of curative effect and prognosis.Methods The clinical data of 63 newly-treated AML patients(except for acute promyelocytic leukemia)in Heze Municipal Hospital of Shandong Province from January 2015 to January 2020 were retrospectively analyzed.No blasts were seen on the blood films of all patients at one week after induction chemotherapy.The receiver operating characteristic(ROC)curve was used to determine the best cut-off value of LMR at one week after the completion of all induction chemotherapy for predicting complete remission(CR)of patients,and based on this value,the patients were divided into the low LMR group(LMR<the best cut-off value)and the high LMR group(LMR≥the best cut-off value).The differences in clinical characteristics,laboratory test indicators,treatment efficacy,recurrence and survival between the two groups of patients were compared.Results Sixty-three patients were enrolled in the study.The median LMR of 63 patients was 3.64(0.13-88.01)at one week after the completion of all induction chemotherapy.Fifty-one patients(81.0%)achieved CR after one course of induction chemotherapy,54 patients(85.7%)achieved CR after two courses,and there were finally 56 patients(88.9%)with CR.The ROC curve determined that the best cut-off value of LMR was 1.515,and there were 20 cases and 43 cases in the low LMR group and the high LMR group,respectively.There were no significant differences in age,gender,hemoglobin,bone marrow blast cell ratio,white blood cell count,platelet count,and lactate dehydrogenase levels between the two groups(all P>0.05).The CR rates after 1 course of treatment in the low LMR group and the high LMR group were 65.0%(13/20)and 88.4%(38/43),respectively,and the difference was statistically significant(χ^(2)=4.836,P=0.028).In the low LMR group,3 of the 13 patients who achieved CR within 1 course of treatment relapsed;in the high LMR group,2 of the 38 patients who achieved CR within 1 course of treatment relapsed.The 3-year RFS rates of the low LMR group and the high LMR group were 64%and 80%,respectively,and the difference was not statistically significant(χ^(2)=2.897,P=0.089);the 3-year OS rates were 84%and 80%,respectively,and the difference was not statistically significant(χ^(2)=0.136,P=0.712).Conclusion For newly-treated AML patients with no nucleated cells in blood smear microscopy at one week after the completion of induction chemotherapy,LMR may be used to evaluate the treatment efficacy and recurrence.