难治性急性髓系白血病预后因素分析

Analysis of prognostic factors in patients with refractory acute myeloid leukemia

目的分析难治性急性髓系白血病(AML)的预后因素,为难治性AML治疗方案的选择提供理论基础。方法选取接受了2个标准DA方案诱导治疗的48例复发性难治性AML患者,分析患者年龄、性别、对标准诱导治疗的反应,遗传学异常、骨髓中白血病细胞比例、外周血情况、髓外浸润以及乳酸脱氢酶(LDH)等因素对患者生存期的影响。结果经Cox回归分析显示,患者在标准诱导治疗后达到完全缓解、缓解期大于6个月、有较好预后的细胞遗传学异常、骨髓白血病细胞比例小于50%、无严重贫血、无肝脾肿大和中枢神经系统白血病、血清LDH小于360 U/L者预后较好;而年龄、性别、外周血白细胞总数以及淋巴结肿大对患者生存期无明显影响。结论对于有较好预后因素的AML患者应给予积极的治疗,争取较长的持续缓解期;对于预后差的病例应尽快予以异基因骨髓移植。

Objective To analyze the prognostic factors in patients with refractory acute myeloid leukemia, so as to provide theoretical basis for choosing an appropriate chemotherapy. Methods This study included 48 patients with refractory acute myeloid leukemia who received two standard DA regimens followed by chemotherapy with median dose of Ara-C and mitox-antrone. The factors such as age, gender, responses to the standard chemotherapy, cytogenetic abnormalities, blast cell counts in the bone marrow, peripheral blood cell counts, extramedullary infiltration exhibition and LDH were examined in light of their respective impact on the patients' survival. Cox regression model was used to analyze the prognostic factors. Results The results revealed that the factors such as achievement of the first complete remission after standard induction chemothera-py, the remission duration longer than 6 months, favorable cytogenetic abnormalities, blast cell counts less than 50% in bone marrow, absence of severe anemia, absence of liver or pancreatic enlargement or central nerves system (CNS) leukemia, and LDH less than 360 U/L, all indicated favorable prognosis of the patients. Age, gender, white cell counts in periphery blood or lymphadenopathy were not related to the survival of the patients. Conclusion The patients with favorable prognostic factors should receive intensive chemotherapy for prolonged survival; allogeneic bone marrow transplantation should be performed as soon as possible in patients with unfavorable prognostic factors.