老年急性髓细胞白血病患者临床特点及预后分析  

Analysis of clinical characteristics and prognosis of elderly patients with acute myeloid leukemia

作　　者：程玮[1] 刘辉[1] 裴蕾[1] 宁尚勇[1] 李江涛[1] 范芸[1] 冯茹[1] 张野坪[1] 田园[1] 邢宝利[1] 许晓东[1] 

机构地区：[1]北京医院血液内科,100730

出　　处：《国际输血及血液学杂志》2015年第4期293-299,共7页International Journal of Blood Transfusion and Hematology

摘　　要：目的探讨老年急性髓细胞白血病（AML）患者的临床特点及影响预后的因素，为其个体化治疗提供依据。方法回顾性分析2003年1月至2013年12月于北京医院血液科收治的92例年龄≥60岁初治老年AML患者的临床病历资料，其中74例接受诱导缓解化疗方案治疗，纳入化疗组；12例接受姑息治疗，纳入姑息治疗组。比较两组患者的疗效及预后差异，并对患者预后及早期死亡[总生存（OS）期≤8周]率影响因素均进行单因素和多因素分析。两组患者年龄，性别构成比，AML法国、美国和英国（FAB）分型及体力状态（Ps）评分等基线资料比较，差异均无统计学意义（P〉0．05）。结果①化疗组患者中位0S期为8．O个月（0．1～175．0个月），显著长于姑息治疗组患者的2．3个月（0．1～14．0个月），且差异有统计学意义（x^2=9．558，P=0．002）。化疗组患者中，65例患者可评价疗效，其中达完全缓解（CR）为28例（43．1％），达CR者的中位OS期（28．4个月）显著长于未达CR者（6．0个月），且差异有统计学意义（x^2=92．048，P=0．000）。本组92例老年AML患者的1年Os率为29．3％（27／92），3年OS率为9．8％（9／92）。②年龄、PS评分、白细胞计数、血清乳酸脱氢酶（LDH）水平、染色体核型及染色体单体核型（MK）均与患者预后相关（P〈0．05）。多因素分析结果显示，PS评分≥3分、白细胞计数≥100．0×10^9／L、血清LDH水平／正常值≥2倍及MK均是影响老年AML患者预后的独立危险因素（RR=5．076，11．263，2．297，5．076；P〈0．05）。③本组92例老年AML患者中，早期死亡21例（22．8％）。化疗组患者早期死亡率为17．6％（13／74），与姑息组患者的41.7％（5／12）比较，差异无统计学意义（x^2=2．314，P=0．128）。对老年AML患者早期死亡率影响因素进行分析发现，与年龄、PS评分、白细胞计�Objective To explore the clinical characteristics and prognostic factors of 92 elderly patients with acute myeloid leukemia （AML）. Methods The clinical data of 92 newly diagnosed patients with AML who were older than 60 years old in Department of Hematology, Beijing Hospital from January 2003 to December 2013 were retrospectively analyzed. Among them, 74 patients who received induction chemotherapy were included into the chemotherapy group, and 12 patients who received palliative treatment were included into the palliative care group. The efficacy and prognosis were compared between two groups. The influential factors of prognosis and early mortality [overall survival （OS） time≤8 weeks] were evaluated by univariate and multivariate analysis. All patients signed the clinical research informed consent. There were no significant differences in the distribution of age, gender ratio, AML French-American-British （FAB） classification and performance status （PS） score between chemotherapy group and palliative care group （P 〉0. 05）. Results O The median OS time in chemotherapy group was 8. 0 months （0. 1- 175.0 months）, which was significantly longer than that in palliative care group 2. 3 months （0. 1-14. 0 months）, and the difference was statistically significant （x^2=9. 558, P= 0. 002）. In the chemotherapy group, 65 patients were evaluable for efficacy, and 28（43.1%） patients achieved complete remission （CR）.The median OS time of patients with CR was significantly longer than that of patients without CR （28.4 months vs 6.0 months, X2= 92. 048, P= 0. 000）. The 1-year OS rate and 3-year OS rate of 92 elderly patients with AML were 29.3%（27/92） and 9.8%（9/92）, respectively. QIt showed that age, PS score, the white blood cell count, level of serum lactate dehydrogenase, chromosome karyotype and monosomal karyotype （MK） were related to the prognosis of elderly patients with AML （P〈0.05）. A multivariate analysis revealed that poor performance （PS score≥3 s

关 键 词：白血病 髓样 急性 老年人 诱导化疗 早期死亡率 预后 

分 类 号：R733.71[医药卫生—肿瘤]