云南地区儿童急性髓细胞白血病(非M3型)临床特征及民族差异研究

Ethnic-specific Clinical Features in Children with Non-M3 Acute Myeloid Leukaemia from Yunnan Province

背景儿童急性髓细胞白血病(AML)是一种高度异质性疾病,但关于AML患儿民族差异与临床关系的研究鲜有报道。目的分析云南地区AML(非M3型)患儿的临床特征及预后,并探究其民族差异。方法收集2015-01-01至2020-03-01昆明市儿童医院收治的初诊AML(非M3型)患儿为研究对象。收集AML患儿的基线临床资料,包括人口学资料(民族、性别、年龄)、一般资料(白细胞计数、血红蛋白、血小板计数、乳酸脱氢酶、骨髓原始细胞数、FAB分型)、染色体核型结果、基因检测结果。从所有患儿入组后开始随访,截至2020-05-31。记录患儿的治疗方案、危险度及预后情况。结果最终纳入AML(非M3型)患儿72例,随访时间为2~60个月;汉族51例,少数民族21例(彝族5例、回族4例、哈尼族3例、白族2例、苗族2例、壮族1例、佤族1例、布依族1例、蒙古族1例、傣族1例)。少数民族患儿白细胞计数高于汉族(P<0.05)。随访截至2020-05-31,汉族和少数民族患儿诱导治疗第一疗程后完全缓解率、复发率、骨髓移植率比较,差异无统计学意义(P>0.05);少数民族患儿危险度、死亡率高于汉族(P<0.05)。随访截至2020-05-31,绘制汉族和少数民族AML患儿的生存曲线进行比较,汉族AML患儿无事件生存率、总生存率高于少数民族(χ^(2)值分别为8.098、12.547,P值分别为0.004、<0.001)。结论云南地区汉族AML患儿危险度分层、预后优于少数民族,但具体原因尚未明确。

Background Childhood acute myeloid leukaemia(AML)is a higly heterogenous disorder.But its clinical characteristics according to ethic groups have been rarely studied.Objective To explore ethnic-specific clinical characteristics and prognosis of paediatric patients with non-M3 AML from Yunnan province.Methods Paediatric patients with newly diagnosed non-M3 AML were rectuited from Kunming Children's Hospital between January 1,2015 and March 1,2020.Basic baseline clinical data,including demographic characteristics(ethnic group,gender,age),general information(white blood cell count,haemoglobin,platelet count,lactate dehydrogenase,bone marrow blast cell,FAB classification),karyotype,and genetic information were collected.All patients were followed up from enrolment to 2020-05-31,and treatment protocols,risk stratifications,and prognoses were collected.Results Seventy-two cases〔51 cases of Han,21 cases of minorities(5 Yi,4 Hui,3 Hani,2 Bai,2 Miao,1 Zhuang,1 Wa,1 Buyi,1 Mongolian and 1 Dai)〕were enrolled,with a follow-up of 2-60 months.Children of ethnic minorities had higher mean white blood cell count did those of Han(P<0.05).Follow-up analysis showed that compared with children of Han,children of ethnic minorities had higher risk and moratlity(P<0.05),but domonstrated simailar complete remission rate,recurrence rate and bone marrow transplantation rate after the first course of induction therapy(P>0.05).Event-free survival rate and overall survival rate of children of Han were higher than those of children of ethnic minorities(χ^(2)=8.098,P=0.004;χ^(2)=12.547,P<0.001).Conclusion Non-M3 AML children of Han had lower risk and better prognosis than those of ethnic minorities in Yunnan,but the reason has not been identified.