诱导治疗失败和复发急性髓系白血病患者获得血液学缓解和生存的影响因素分析

Variables associated with hematological remission and survival in patients with acute myeloid leukemia after induction failure and relapse

目的探索诱导化疗失败和复发急性髓系白血病(AML)患者缓解、复发、生存的影响因素。方法回顾性收集2008年1月1日至2021年5月1日北京大学人民医院收治的诱导化疗失败和复发AML连续病例,采用二元Logistics和Cox比例风险回归模型分析患者治疗反应和结局的影响因素。结果180例诱导化疗失败和193例复发AML患者,最终完全缓解(CR)/CR伴血细胞未完全恢复(CRi)率分别为50.6%和40.3%;获得CR/CRi人群中,3年无复发生存(RFS)率分别为34.4%和30.4%,3年总生存(OS)率分别为40.1%和31.6%。多因素分析显示,诱导化疗失败患者中,CLAG或FLAG方案作为再诱导化疗方案、年龄<39岁和SWOG预后分层低危和缓解率高相关;复发患者中,男性、继发AML、SWOG预后分层高危、12个月内复发和复发时骨髓原始细胞比例≥20%和缓解率低相关(P值均<0.05)。对于获得CR/CRi的患者,移植是影响RFS和OS的共同因素;此外,SWOG预后分层与诱导化疗失败患者的OS率显著相关,获得CR而非CRi与复发患者的RFS率相关,男性复发患者的OS率低于女性。结论对于诱导化疗失败和复发AML患者,再诱导化疗方案、SWOG预后分层、年龄、性别、继发或初发AML、首次缓解距复发时间、复发时骨髓中原始细胞比例是影响缓解的独立因素;移植、SWOG预后分层、缓解时血细胞恢复状态和性别影响获得缓解者的生存。

Objective This study aimed to explore variables associated with remission rate and survival in patients with acute myeloid leukemia(AML)after induction failure and relapse.Methods Data of 373 consecutive patients with AML were analyzed after induction failure and relapse.Binary logistics and the Cox model regression were used to identify variables associated with remission rate and outcomes.Results In patients with AML after induction failure and relapse,the total CR+CRi rates were 50.6%and 40.3%,respectively;among those who achieved CR/CRi,the 3-year RFS rates were 34.4%and 30.4%,respectively,and the 3-year overall survival rates were 40.1%and 31.6%,respectively.In the multivariate analyses,using CLAG or FLAG regimen as a re-induction chemotherapy regimen,age<39 years and SWOG low-risk were significantly associated with higher remission rates in patients with induction failure.Male,secondary AML,SWOG high-risk,the interval from the first remission to relapse within 12 months,and bone marrow blasts≥20%at the time of relapse were significantly associated with lower remission rates in relapsed patients.Transplantation was significantly associated with prolonged relapse-free survival and overall survival in patients achieving hematologic remission;the SWOG low-risk group was significantly associated with longer overall survival in those with induction failure;and achieving CR(not CRi)or having female gender was associated with longer RFS or overall survival in relapsed patients.Conclusion Reinduction chemotherapy regimen,age,gender,SWOG risk,secondary AML,the interval from the first remission to relapse,and bone marrow blast percentage at the time of relapse were significantly associated with remission rates in the patients with AML after induction failure and relapse.Transplantation,SWOG low-risk,achieving CR,or female gender were associated with longer survivals in those achieving remission.