老年人急性髓系白血病临床特点及疗效分析  

Analysis of clinical characteristics and treatment effect of acute myeloid leukemia in elderly patients

作　　者：张野坪[1] 常乃柏[1] 魏建平[1] 范芸[1] 刘辉[1] 李江涛[1] 赵声明[1] 邢宝利[1] 裴蕾[1] 许小东[1] 

机构地区：[1]卫生部北京医院血液内科,100730

出　　处：《中华老年医学杂志》2010年第8期658-661,共4页Chinese Journal of Geriatrics

摘　　要：目的 探讨老年人急性髓系白血病（AML）的临床特点及生物学特征.方法 回顾性分析62例60岁以上AML患者的临床资料,并与同期住院的60例中青年患者进行比较.结果 老年组完全缓解率27.7%,总有效率44.7%,中青年组分别为74.1%和87.9%（P＜0.01）.老年组早期病死率19.0%,诱导期病死率29.3%,均高于中青年组（3.3%和6.7%,P＜0.01）.老年组伴骨髓增生异常综合征（MDS）病史者占27.4%,中青年组仅10.0%（P＜0.05）,继发于MDS的AML患者CR率低于无MDS病史者（P＜0.05）.老年组伴淋系抗原表达者占28.2%,CD34＋者占71.8%,均高于中青年组（8.1%和48.6%,P＜0.05）,其CR率均低于仅有髓系抗原表达者和CD34-者（P＜0.05）.老年组预后不良核型发生率高于中青年组（分别为45.7%和15.4%,P＜0.05）.结论 老年AML患者具有多种不良预后因素,总体缓解率低,病死率高,在临床上有其特殊性,治疗上更强调个体化.Objective To explore the clinical and biological characteristics and treatment effect of acute myeloid leukemia （AML） in elderly patients. Methods The clinical data of 62 patients over 60 years old with AML were retrospectively analyzed, and they were compared with those of 60 younger adult patients （18-59 years old） at the same period. Results In elderly patients, the complete remission （CR） rate was 27. 7% and the overall effective rate was 44.7%, which were lower than those of younger adult patients （74.1% and 87.9 %, 1-espectively, P〈0.01）. The early death rate was 19.0% and the mortality rate during the first two induction chemotherapy was 29. 3% in the elderly, which were higher than those of younger adult patients （3. 3% and 6.7%, 1-espectively,P〈0.01）. The 27.4% of elderly patients were diagnosed as myelodysplastic syndrome （MDS）-transformed AML, which were more than that of younger adult patients （10.0%, P〈0.05）, and they had lower CR rate than those without MDS （P〈0. 05）. The 28.2% of elderly patients had lymphoid antigen positive AML and 71.8% of patients showed CD34＋ which were higher than those of younger adult patients （8. 1% and 48.6%, respectively, P〈0. 05）, and they had lower CR rate than those of lymphoid antigen negative and those of CD34- AML （P〈0. 05）. Elderly patients had less favorable and more unfavorable karyotypes than younger adult patients （45.7 % and 15.4 %, P〈0. 05）. Conclusions The elderly patients with AML have more unfavorable prognostic factors than younger adult patients. They have lower CR rate and higher mortality rate. There are many specialties in elderly patients and the treatment strategy should be made more individually.

关 键 词：白血病 粒细胞 急性 

分 类 号：R733.71[医药卫生—肿瘤]