高白细胞急性髓系白血病的临床分析  

Clinical analysis of hyerleukocytic adult acute myeloid leukemia

作　　者：姜波[1] 秘营昌[1] 张静[1] 林冬[1] 魏辉[1] 刘兵城[1] 李巍[1] 周春林[1] 王迎[1] 刘旭平[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白血病诊疗中心,天津300020

出　　处：《临床血液学杂志》2011年第3期262-266,269,共6页Journal of Clinical Hematology

基　　金：国家高技术研究发展计划(863计划)项目(No:2006AA02A405)

摘　　要：目的:探讨高白细胞急性髓系白血病(HAML)患者的临床特征、预后并与同期非高白细胞急性髓系白血病(NHAML)患者进行比较。方法:观察随访66例HAML(WBC≥100×109/L)病例(非M3型),分析并发症、早期死亡(early death,ED)、治疗反应、远期预后等,并与同期随机选择的202例NHAML(WBC<100×109/L)病例(非M3型)进行比较。结果:①HAML病例发生低钾血症、出凝血异常、感染、肺白细胞淤滞、脾脏肿大、淋巴结肿大等并发症的概率高于NHAML病例(P<0.05)。HAML病例FAB分型以M4/M5型为主。②HAML病例ED 4例(6.1%),ED与出凝血异常(P<0.01)、肺白细胞淤滞(P<0.01)、CNS白细胞淤滞症状(P<0.01)相关。③HAML病例CR率66.7%,且M4/M5型CR率低。HAML病例3年DFS率为45.7%,3年OS率为32.5%。完全缓解(CR)率与年龄、是否为M4/M5型相关(P<0.05)。3年无病生存率(DFS)与是否>50岁及染色体分组相关(P<0.01)。3年总生存率(OS)与是否CR相关(P<0.05)。NHAML病例CR率为90.5%,3年DFS为44.7%,3年OS为45.6%,与HAML病例比较CR、3年OS差异有统计学意义(P<0.01),3年DFS差异无统计学意义(P>0.05)。即使去除ED病例,二者的3年OS仍差异有统计学意义。结论:HAML病例具有其特有的临床特点。Objective：To investigate the clinical characteristics and outcome of adult patients with newly diagnosed hyerleukocytic acute myeloid leukemia（non M3）.Method：Data of 66 de novo HAML（non M3） patients were retrospectively reviewed.The outcomes of these patients was compared with 202 patients with leukocyte count lower than 100×109/L（NHAML）admitted in the same period.Data were analyzed with the SPSS15.0 software.Result：①Compared with NHAML,HAML has a high incidence of hypokalemia,consumption coagulopathy,infection,pulmonary leukostasis,splenomegaly and lymphadenectasis（P0.05）.Most of HAML patients are FAB M4/M5 subtypes.② Four hyperleukocytic patients（6.1%） died within 10 days of treatment.A significant association was found between early death（ED） and consumption coagulopathy,pulmonary leukostasis、central nervous system（CNS） leukostasis.③ CR rate,3-year disease-free survival（DFS）,3-year overall survival（OS） in HAML patients are 66.7%,45.7%,32.5%,respectively.CR rate is associated with age and FAB subtype.DFS is associated with age and karyotype.CR rate,3-year DFS,3-year OS in NHAML patients are 90.5%,44.7%,45.6% respectively.Hyperleukocytosis significantly reduces the CR rate and the 3-year OS（P0.01）,but does not significantly influence the 3-year DFS（P 0.05）.Conclusion：HAML patients have special characteristics.CR rate and the 3-year OS were different between HAML patients and NHAML patients,but the DFS was similar.

关 键 词：白血病 髓系 急性 高白细胞 预后 

分 类 号：R733.71[医药卫生—肿瘤]