老年人急性髓细胞白血病非遗传学预后因素及化疗疗效分析  

The non-cytogenetic prognostic factors and efficacy of chemotherapy in elderly adults with acute myeloid leukemia

作　　者：张国香[1] 张海燕[1] 申徐良[1] 魏明霞[1] 梁莉[1] 郭睿鹏[1] 翟春燕[1] 王海丽[1] 

机构地区：[1]山西省长治医学院附属和平医院血液科,长治046000

出　　处：《中华老年医学杂志》2016年第5期517-520,共4页Chinese Journal of Geriatrics

摘　　要：目的探讨老年急性髓细胞白血病（acute myeloid leukemia，AML）患者的非遗传学预后因素，对化疗方案疗效进行分析。方法采用回顾性研究方法，分析2010年1月至2015年7月我院收治的103例首诊初治老年（年龄≥60岁）AML患者的临床资料，其中DA方案（柔红霉素45～60mg／m^2，静脉滴注，1次／d，d1～d3＋阿糖胞苷100mg／m^2，静脉滴注，1次／d，d1～d7）组患者28例，CAG方案（阿克拉霉素20mg／m^2，静脉滴注，1次／d，d1～d4＋阿糖胞苷10mg／m^2，肌肉注射，1次／12h，d1～d14＋粒细胞集落刺激因子200μg／m^2，皮下注射，1次／d，d1～d14）组为43例，姑息治疗组为32例。比较化疗方案的疗效，并对患者预后进行单因素和多因素分析。结果化疗组（DA方案组＋CAG方案组）与姑息治疗组中位生存时间分别为10．7个月比2．3个月（Х^2=29．06，P〈0．01）；CAG方案组早期病死率与明显低于DA方案组（0．0％比14．3％，Х^2=6．51，P=0．021）；两组完全缓解（CR）率为44．2％比54．2％（Х^2=0．03，P=0．853），总有效率为67．4％比67．9％（Х^2=1．04，P=0．307），差异无统计学意义。两组6个月无病生存（DFS）率分别为37．2％比41．6％，差异无统计学意义（Х^2=0．13，P=0．720）。经多元COX比例风险模型多因素分析显示，入院时白细胞计数≥100×10^9／L、美国东部肿瘤协助组（ECOG）344分及治疗后未完全缓解，是老年AML患者预后的独立危险因素。结论入院时白细胞计数〉100×10^9／L、ECOG3～4分及治疗后未完全缓解等非遗传学因素是影响老年AML患者预后的独立危险因素。CAG方案是部分一般情况差难以耐受化疗患者的较好选择，低强度多疗程巩固化疗能延长生存期。Objective To investigate the non-cytogenetic prognostic factors and analyze the efficacy of chemotherapy treatment in elderly adults with acute myeloid leukemia（AML）. Methods Clinical data of 103 de novo AML patients aged 60 years and over in our hospital from January 2010 to October 2015 were retrospectively analyzed. 28 patients received protocol DA（daunorubicin 45 - 60 mg/m^2 by intravenous infusion, qd for d1-d3, plus cytarabine 100 mg/m^2 by intravenous infusion, qd for d1-d7）, 43 patients received protocol CAG（aclacinomycin 20 mg/m^2 by intravenous infusion, qd for d1-d4, cytarabine 10 mg/m^2 by intramuscular injection, 1 times/12 hours for d1-d14, plus granulocyte colony-stimulating factor 200 μg/m^2 by subcutaneous injection, qd for d1-d14）, while 32 patients received palliative treatment. The efficacy was compared between patients with three different protocols. Their prognoses were investigated by univariate and muhivariate analysis. Results The patients receiving chemotherapy （DA ＋ CAG） had a longer median overall survival （OS） than those receiving palliative treatment（10.7 months vs. 2.3 months, （Х^2=29.06, P〈0. 001）. The early death rate was lower in.CAG group than in DA group（0% vs. 14.3%, （Х^2=6.51, P=0.021）. No significant differences were found in complete remission（CR）rate and total effective rate between the CAG group and the DA group（44.2% vs. 54.2%, 67.4% vs. 67.9%, Х^2=0.03 and 1.04, P= 0. 853 and 0. 307）. There was no difference in disease-free survival（DFS）rate at 6 months between two groups（37.2% vs. 41.6%, （Х^2=0.13, P=0.720）. Multivariate analysis with Cox proportional hazard model showed that the increased WBC counts （≥100×10^9/L）on admission, Eastern Cooperative Oncology Group （ECOG）score 3-4 and non-remission （NR）after treatment were the independent risk factors for the prognosis of AML in the elderly. Conclusions The non-cytogenetic factors, such as the increased WBC counts （≥100×10^9/L） on admission, E

关 键 词：白血病 髓样 急性 抗肿瘤联合化疗方案 预后 

分 类 号：R733.71[医药卫生—肿瘤]