老年急性髓系白血病患者临床特征和预后因素评估  

Clinical characteristics and assessment of prognostic factors of acute myeloid leukemia in elderly patients

作　　者：程玮[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》2013年第11期1192-1197,共6页Chinese Journal of Geriatrics

摘　　要：目的探讨老年急性髓系白血病（acutemyeloidleukemia，AML）的临床特点及预后因素，为临床治疗选择提供依据。方法回顾性分析82例年龄60～85岁AML患者的临床资料，比较行诱导缓解化疗和姑息治疗患者的疗效及预后，并分析临床及生物学特点与预后的关系。结果74例患者行诱导缓解化疗，59例可评价疗效，其中完全缓解（completeremission，CR）26例（44．1％），部分缓解（partialremission，PR）12例（20．3％），总有效率64．4％。接受诱导缓解化疗患者早期死亡17例（23．0％），中位生存期8．2个月，化疗后CR患者中位生存期长于未达CR患者（28．4个月与5．8个月，x231．362，P=0．000）。8例患者接受姑息治疗，早期死亡3例（37．5Vo），中位生存期2．3月。接受诱导缓解化疗与姑息治疗患者比较，中位生存期有差异（x=24．509，P=0．034），早期病死率无差异（x2=0．826，P=0．396）。多因素分析结果显示，年龄≥80岁、体力状况（performancestatus，PS）评分≥3分、血清乳酸脱氢酶（1actatedehydrogenase，LDH）升高≥2倍、伴淋巴细胞系抗原表达及预后不良染色体核型是影响老年AML患者预后的独立危险因素。结论老年AML患者具有独特的临床和生物学特点，应结合临床及生物学因素进行预后分层，给予个体化治疗。Objective To explore the clinical characteristics and prognostic factors of acute myeloid leukemia （AML） in elderly patients, and to provide clinical basis for treatment selection. Methods Clinical data of 82 patients with AML aged 60-85 years were retrospectively analyzed. Efficacy and prognosis were compared between patients receiving induction chemotherapy and palliative treatment. The relationship of prognosis with clinical and biological characteristics were evaluated. Results There were 74 patients receiving induction chemotherapy, among whom 59 patients were evaluable for efficacy. The complete remission （CR） rate was 44.1% （26 eases）, partial remission （PR） rate was 20.3% （12 cases）, and total efficiency was 64.4%. Early death rate was 23.0% and the median survival time was 8.2 months in patients receiving induction chemotherapy. The median survival time was longer in patients with CR than in patients without CR （28.4 months vs. 5.8 months, Z2 =31. 362,P〈0. 001）. There were 8 patients receiving palliative treatment. Early death rate was 37.5% （3 cases） and the median survival time was 2.3 months. There was a significant difference in median survival time between patients receiving remission induction chemotherapy and palliative treatment （X2= 4. 509, P%0.05）, while there was no significant difference in early death rate between the two groups X2= 0. 826, P〈 0.05）. Multivariate analysis revealed that age80 years, poor performance （x3 scores）, elevated lactate dehydrogenase （2 times more than up limit of normal range）, positive lymphoid antigen and unfavorable cytogenetics were independent poor prognostic factors. Conclusions Elderly patients with AML have unique clinical and biological characteristics. Individualized treatment should be applied on the basis of clinical and biologicalprognosis factors in elderly patients.

关 键 词：白血病 髓样 急性 预后 危险因素 

分 类 号：R733.71[医药卫生—肿瘤]