放疗在急性白血病合并髓外浸润的疗效和预后分析

Analysis of the efficacy and prognosis of radiotherapy in acute leukemia with extramedullary infiltration

目的探讨急性白血病合并髓外浸润患者的临床特点、治疗方法和预后。方法回顾性分析贵州医科大学附属医院2014年4月至2023年4月收治的47例急性白血病合并髓外浸润患者的临床特点、治疗方法,根据接受的治疗将患者分为放疗组(n=23)与未放疗组(n=24);根据移植前是否有髓外浸润及移植后是否出现孤立髓外复发进行亚组分析,分为移植前放疗组与移植前未放疗组、移植后放疗组与移植后未放疗组;根据中枢神经系统白血病(CNSL)患者治疗方法分为鞘内注射组(n=12)与鞘内注射联合放疗组(n=13)。比较放疗、化疗等方法治疗后患者的局部缓解情况、生存时间及毒副反应。结果急性白血病合并髓外浸润患者中放疗组总生存时间(OS)优于未放疗组(中位OS:706 d vs.151 d,P=0.015);亚组分析显示移植前放疗组OS优于移植前未放疗组(中位OS:592 d vs.386 d,P=0.035);CNSL鞘内注射联合放疗组OS优于鞘内注射组(中位OS:547 d vs.388 d,P=0.045)。放疗组无事件生存时间(EFS)优于未放疗组(中位EFS:175 d vs.50 d,P=0.005)。COX比例风险模型显示,放疗和未放疗对急性白血病合并髓外浸润患者的OS有明显影响,移植前未放疗组相比移植前放疗组死亡风险增加了2.231倍(HR=3.231,95%CI:1.021~10.227,P=0.046)。相比未放疗组,放疗组局部缓解率更高,且具有更低的血液学毒性反应、感染和出血风险。结论放射治疗可迅速缓解急性白血病合并髓外浸润的局部症状,延长这部分患者的生存时间,且血液学毒性反应、感染和出血风险较低。

Objective To investigate the clinical characteristics,treatment methods,and prognosis of acute leukemia patients with extramedullary infiltration.Methods The clinical characteristics and treatment methods of 47 acute leukemia patients with extramedullary infiltration admitted to the Affiliated Hospital of Guizhou Medical University from April 2014 to April 2023 were retrospectively analyzed.Subgroup analysis was performed according to whether there was extramedullary infiltration before transplantation,and whether there was isolated extramedullary recurrence after transplantation.Based on this analysis,the patients were divided into the pre-transplantation radiotherapy group and pre-transplantation non-radiotherapy group,the post-transplantation radiotherapy group and post-transplantation non-radiotherapy group.According to the treatment methods of central nervous system leukemia(CNSL),the patients were divided into the intrathecal injection group(n=12)and combination of intrathecal injection and radiotherapy group(n=13).The local remission situation,survival duration,and toxic and side effects of radiotherapy and chemotherapy were compared.Results For acute leukemia patients with extramedullary infiltration,the overall survival time(OS)in the radiotherapy group was better than that in the non-radiotherapy group(median OS:706 d vs.151 d,P=0.015).Subgroup analysis showed that the OS of the pre-transplantation radiotherapy group was better than that of the pre-transplantation non-radiotherapy group(median OS:592 d vs.386 d,P=0.035).For CNSL,the combination of intrathecal injection and radiotherapy group had a better OS than the intrathecal injection group(median OS:547 d vs.388 d,P=0.045).The event-free survival time(EFS)of the radiotherapy group was better than that of the non-radiotherapy group(median EFS:175 d vs.50 d,P=0.005).The COX proportional-hazards model showed that treatment with or without radiotherapy had a significant impact on the OS of acute leukemia patients with extramedullary infiltration.The risk of death in the pre-transplantation non-radiotherapy group was 2.231 times higher than that in the pre-transplantation radiotherapy group(HR=3.231,95%CI:1.021-10.227,P=0.046).Compared with the non-radiotherapy group,the radiotherapy group had a higher local remission and a lower risk of haematological toxicity,infection,and haemorrhage.Conclusion Radiotherapy can rapidly alleviate the local symptoms of acute leukemia complicated with extramedullary infiltration,prolong the survival time of these patients,and reduce the risk of hematologic toxicity,infection,and haemorrhage.