急性早幼粒细胞白血病170例长期生存分析  

Long-Term Survival Analysis in 170 Cases of Acute Promyelocytic Leukemia

作　　者：李新[1] 赵耀中[1] 李增军[1] 李云涛[1] 李妍[1] 万长春[1] 李桥川[1] 邓书会[1] 杨仁池[1] 韩明哲[1] 邱录贵[1] 

机构地区：[1]中国医学科学院,中国协和医科大学血液学研究所,血液病医院,天津300020

出　　处：《中国实验血液学杂志》2006年第3期437-441,共5页Journal of Experimental Hematology

摘　　要：本研究探讨影响急性早幼粒细胞白血病(APL)患者长期生存的预后因素。在回顾性分析了1990年1月至2004年12月本院170例APL患者的临床资料后,应用Log-Rank检验和Cox回归模型对170例患者的性别、年龄、初诊时白细胞(WBC)计数、血清乳酸脱氢酶水平、诱导缓解方案、获得缓解时间、缓解后治疗方案、PML/RARα阳性率进行单因素和多因素综合分析。结果表明:170例患者中位随访36个月(6-185个月),5年预计总体生存率(OS)为(80.9±4.0)%,5年预计无复发生存率(RFS)为(71.0±4.0)%。23例患者于中位缓解后15个月(6-70个月)复发。单因素分析显示,初诊时WBC计数、诱导缓解方案、获得缓解时间、缓解后治疗方案、PML/RARα阳性率均为影响APL患者长期生存的主要因素;多因素分析显示,缓解后治疗方案是影响APL患者长期生存的重要的独立因素。结论:在APL患者获得完全缓解后,应用化疗+维甲酸+砷剂的缓解后治疗方案将显著延长患者的生存时间。This study was aimed to investigate various factors influencing long-term survival in patients with acute promyelocytic leukemia. A single institutional retrospective study with long-term follow-up was perfomed to better define the prognostic factors and a rationale for the use of ATRA, chemotherapy, and As2O3 in the treatment of newly diagnosed APL patients. Newly diagnosed patients with APL entering complete remission （CR） were followed up for 6 to 185 months （n=170） from January 1990 to December 2004. Univariate and multivariate analysis of 8 potential factors influencing survival and prognosis were carried out with Log-Rank and Cox regression method, including sex, age, initial WBC count, the level of lactic hydrogenase （LDH）, first induction regimen, time from induction therapy to CR, post-remission therapy, negative or positive rate of PML-RAR alpha and follow-up of reverse transcdption-polymerase chain reaction （RT-PCR）. The results showed that the estimated 5-year overall survival （OS） and relapse-free survival （RFS） were 80.9% ±4.0% and 71.0% ±4.0% respectively. The 23 patients relapsed at the median time of 15 months （6-70）after CR. Univariate analysis revealed that initial WBC count, first induction regimen, time from induction therapy to CR, type of post-remission therapy and persistent negative RT-PCR in remission were important prognostic factors for long-term survival. Multivariate study demonstrated that only type of post-remission therapy was associated with RFS and OS. It is concluded that the post-remission treatment combining ATRA, As2O3 and chemotherapy would significantly improve the long-term survival of APL patients entering CR1.

关 键 词：急性早幼粒细胞白血病 长期生存 预后因素 

分 类 号：R733.71[医药卫生—肿瘤]