复发、难治性急性髓系白血病患者预后的影响因素分析

An analysis of the factors influencing the prognosis of patients with recurrent or refractory acute myeloid leukemia

目的探讨复发、难治性急性髓系白血病(AML)患者预后的影响因素。方法回顾性分析49例复发、难治性AML患者的临床资料,采用logistic回归分析和Kaplan-Meier生存曲线分析患者治疗后完全缓解(CR)和总生存期(OS)的可能影响因素。结果49例患者经挽救性治疗后,CR 15例,未缓解34例;CD7表达、染色体核型和Fms样酪氨酸激酶3(FLT3)基因突变影响复发、难治性AML患者挽救性治疗疗效(P<0.05)。多因素logistic回归分析显示,低、中危的预后危险分层是复发、难治性AML患者治疗后CR的保护性因素(P<0.05),CD7阳性表达、异常染色体核型和有FLT3基因突变是其危险因素(P<0.05)。CD7阳性表达患者中位OS较CD7阴性表达患者缩短(9.0个月vs.20.5个月)(P<0.05);异常染色体核型患者中位OS较正常染色体核型患者缩短(11.5个月vs.20.5个月)(P<0.05)。结论预后危险分层、CD7表达、染色体核型及FLT3基因突变是AML复发、难治的影响因素;新型靶向药物联合化疗可能促进复发、难治性AML患者CR,可尽早进行异基因造血干细胞移植。

Objective To investigate the factors influencing the prognosis of the patients with recurrent or refractory acute myeloid leukemia(AML).Methods The clinical data of 49patients with recurrent or refractory AML were retrospectively analyzed.The possible factors influencing the complete remission(CR)and overall survival(OS)of the patients after treatment were analyzed by logistic regression analysis and Kaplan-Meier survival curve.Results Of 49patients undergoing salvage treatment,15cases achieved CR,and 34cases were still not in remission.The CD7expression,karyotype and FLT3gene mutation were the factors influencing the efficacy of salvage treatment in the patients with recurrent or refractory AML(P<0.05).The multivariate logistic regression analysis showed that low and moderate risk stratification was the protective factor for the CR after treatment in the patients with recurrent or refractory AML(P<0.05),while the positive expression of CD7,abnormal karyotype and FLT3gene mutation were the risk factors(P<0.05).The median OS in the patients with positive expression of CD7was shorter than that in the patients with negative expression of CD7(9.0months vs.20.5months)(P<0.05),which in the patients with abnormal karyotype was shorter than that in the patients with normal karyotype(11.5 months vs.20.5 months)(P<0.05).Conclusion The risk stratification,CD7expression,karyotype and FLT3gene mutation are the factors influencing the recurrence or refractoriness of AML.The new targeted drugs combined with chemotherapy may improve the CR of the patients with recurrent or refractory AML,and the allogeneic hematopoietic stem cell transplantation can be carried out as early as possible.