老年急性髓系白血病的特点及疗效分析  

Analysis of characteristics and clinical effectiveness of acute myeloid leukemia in the elderly

作　　者：于凡[1] 林冬[1] 周春林[1] 秘营昌[1] 王迎[1] 付明伟[1] 刘兵城[1] 魏辉[1] 卞寿庚[1] 王建祥[1] 

机构地区：[1]中国医学科学院北京协和医学院血液学研究所血液病医院实验血液学国家重点实验室,天津300020

出　　处：《临床血液学杂志》2010年第5期513-516,共4页Journal of Clinical Hematology

基　　金：863计划(No:2006AA02A405);国家自然科学基金(No:30700419)

摘　　要：目的：分析我国老年急性髓系白血病（AML）的临床、生物学特点,疗效及预后,为临床诊治提供参考。方法：回顾性分析1995年4月-2008年2月收住院诊治的AML患者共167例,采用FAB及MICM分型诊断标准确诊。运用SPSS15.0软件进行统计学分析。率的比较采用χ2检验,生存分析采用生命表法及Kaplan-Meier法,不同组别的差异采用log-rank法检验。采用Cox回归分析影响生存的预后因素。结果：①我国老年AML以M2（M2a）、M5为主,染色体核型预后良好组比例低,并发慢性疾病较多,具有多种不良的预后因素。②58例接受标准＂3＋7＂方案诱导化疗的非M3患者完全缓解（CR）率达70.7%,中位总生存（OS）期为6.8（0.6~100.2）个月。41例CR患者中位无病生存（DFS）期为5.2（0.2~99.0）个月。1年DFS概率为41%,1年OS概率为51%。早期死亡率12.9%。③分析细胞生物学特征与疗效的关系,发现前驱血液病史、骨髓病态造血及染色体核型对CR率的影响具有统计学意义。结论：我国老年AML以M2（M2a）、M5为主,具有多种不良的预后因素。部分患者可受益于强诱导化疗。影响疗效的主要因素有染色体核型、前驱血液病史和骨髓病态造血。Objective：To analyze clinical and biological characteristics,prognosis and clinical effectiveness of acute myeloid leukemia（AML） in the elderly so as to provide reference for clinical diagnosis and treatment plans.Method：We conducted a retrospective analysis of 167 elderly AML patients hospitalized between April,1995 and February,2008,all of whom were diagnosed by FAB and MICM standard.The SPSS15.0 software was applied for statistical analysis.Differences among variables were compared by chi square tests.Survival analysis was done by life table and the Kaplan-Meier method,and compared by the log rank test.Multivariate analysis of prognostic factors for survival by Cox proportional hazard method was used.Result：①The major FAB types in elderly AML patients were M2（M2a） and M5.The percentage of patients with favorable cytogenetics was very low.Most patients were complicated with chronic diseases and had many unfavorable prognostic factors.②The 58 cases of nonpromyelocytic AML who were ＂induced＂ with the standard ＂3＋7＂ style regimens achieved CR in 70.7% cases,with a median OS of 6.8（0.6~100.2） months and a median DFS of 5.2（0.2~99） months for 41 cases with CR.The one year DFS probability was 41% and one year OS probability was 51%.The early death rate was 12.9%.③The relationship between biological characteristics and clinical effectiveness was analyzed and we found that a history of hematological diseases,dyshaematopoiesis and karyotype are the factors that have a significant effect on CR rate.Conclusion：Elderly AML patients were mainly classified into the M2（M2a） and M5 FAB types with many unfavorable prognostic factors.A well selected group may benefit from the intensive induction therapy.Factors related to clinical effectiveness included karyotype,hematological disease history and dyshaematopoiesis.

关 键 词：白血病 老年 急性 核型分析 治疗疗效 

分 类 号：R733.71[医药卫生—肿瘤]