t(8;21)(q22;q22)伴Y染色体丢失急性髓系白血病临床分析  

Clinical Analysis of Acute Myeloid Leukemia with t(8;21)( q22;q22) and Loss of Y Chromosome

作　　者：朱成英[1] 杨华[1] 牛建花[2] 张琪[3] 谢旭磊[4] 王利军[5] 朱海燕[1] 姚子龙[1] 于力[1] 靖彧[1] 

机构地区：[1]解放军总医院血液科,北京100853 [2]山东省济南市第四人民医院血液科,山东济南250031 [3]江苏省南京市高淳县人民医院血液科,江苏南京211300 [4]河北省保定市第一院血液科,河北保定071000 [5]解放军264医院血液科,山西太原030001

出　　处：《中国实验血液学杂志》2014年第4期950-956,共7页Journal of Experimental Hematology

摘　　要：本研究旨在探讨t(8;21)(q22;q22)伴Y染色体丢失急性髓系白血病(acute myeloid leukemia,AML)临床特征。回顾性分析我院2010年1月至2013年6月收治AML患者267例,其中13例为t(8;21)(q22;q22)伴Y染色体丢失,对13例患者临床指标、治疗方案、疗效及预后进行回顾性分析。结果表明,在13例患者经过规范化疗后,4例1个疗程获缓解,4例2个疗程获缓解,4例3个疗程获缓解,1例4个疗程仍未获缓解。缓解后在巩固强化治疗过程中未复发有6例,其中4例采用化疗联合移植方案,另外2例采用单纯化疗;其余6例分别为4例复发1次、1例复发2次、1例复发3次,并且2例是化疗联合自体移植后复发,复发后继续给予异基因造血干细胞移植,目前处在无病状态。在随访期间,化疗组无复发生存(RFS)时间为4.67±3.45个月,化疗联合移植组RFS时间为34.17±21.37个月,显示采用化疗联合移植方案可以显著延长RFS(P<0.05)。结论:2013年NCCN指南将伴t(8;21)(q22;q22)定义为预后良好型,目前未明确指出此型伴Y染色体丢失预后差,难缓解,易复发,但是近几年临床治疗过程中发现t(8;21)(q22;q22)伴Y染色体丢失预后差,难缓解,易复发,建议对此类患者行造血干细胞移植以改善预后。This study was aimed to investigate the clinical characteristics of acute myeloid leukemia （AML） with t （ 8 ;21 ） （ q22; q22 ） and loss of Y chromosomes. Clinical data of 267 cases of AML were collected from January 2010 to June 2013. Among 267 AML, there were 13 cases with t（ 8 ;21 ） （ q22 ; q22） and loss of Y chromosomes. The clinical data including clinical indicators, treatment protocols, curative effect and prognosis were analyzed retrospectively. The results showed that after normalized chemotherapy, there were 4 patients with complete remission at the first cycle of treatment, 4 patients with complete remission at the second cycle, 4 patients with complete remission at the third cycle, but one patient without complete remission after 4 cycles. There were 6 patients who did not relapse during consolidation and intensive therapy. Among these 6 patients, 4 cases accepted chemotherapy combined with transplantation, other 2 cases accepted chemotherapy. In the remainder 6 patients, 4 cases relapsed once, one cases relapsed twice, 1 cases relapsed for three times. Moreover, 2 cases who accepted the chemotherapy and auto-hematopoietic stem cell trans- plantation, were diagnosed as relapse, after accepted allo-hematopoietic stem cell transplantation, currently are in disease-free status. In follow-up period, the relapse-free survival （ RFS ） time was 4.67 ± 3.45 months in chemotherapy group, the RFS time is 34.17±21.37 months in chemotherapy and transplantation group. The chemotherapy combined with transplantation extended the RFS time （ P 〈 0. 05 ）. It is concluded that the NCCN guide indicats that AML with t （8 ;21 ） （ q22 ;q22 ） showed a good prognosis, but the clinical course of treatment confirmed that the prognosis of AML patients with t（ 8 ;21 ） （q22;q22） and loss Y chromosomes is poor, including uneasy remisson and easy relapse, for improving the prognosis of these patients, the hematopoietic stem cell transplantation shoud be recommended.

关 键 词：t(8 21) (q22 q22) Y染色体丢失 急性髓系白血病 

分 类 号：R733.71[医药卫生—肿瘤]