首次获骨髓无白血病状态时血细胞恢复程度在成人急性髓系白血病患者中的预后意义  

Prognostic significance of blood count at the time of achieving morphologic leukemia-free state in adults with acute myeloid leukemia

作　　者：任欣[1] 赵婷[1] 王婧[1] 主鸿鹄[1] 江浩[1] 贾晋松[1] 杨申淼[1] 江滨[1] 王德炳[1] 黄晓军[1] 江倩[1] Ren Nin Zhao Ting Wang Jing Zhu Honghu Jiang Hao Jia Jinsong Yang Shenmiao Jiang Bin Wang Debing Huang Xiaojun Jiang Qian(Peking University People＇s Hospital, Peking University Institute of Hematology, Beijing 100044, China)

机构地区：[1]北京大学人民医院、北京大学血液病研究所,100044

出　　处：《中华血液学杂志》2017年第3期185-191,共7页Chinese Journal of Hematology

摘　　要：目的探讨首次获骨髓无白血病状态时血细胞恢复程度[包括完全缓解（CR，ANC≥1．0×10^9／L和PLT≥100×10^9／L）、PLT未恢复（CRp）、ANC和PLT均未恢复（CRi）]对初治成人急性髓系白血病（AML）患者预后的影响。方法回顾2008年1月至2016年2月北京大学人民医院收治的获得骨髓无白血病状态后持续化疗AML（非急性早幼粒细胞白血病）连续病例，分析诊断时疾病特征、诱导化疗方案、首次诱导化疗反应以及骨髓无白血病状态时血细胞计数与预后的关系。结果352例患者，男179例（50．9％），中位年龄44（17～65）岁。按美国西南肿瘤组（SWOG）标准分组：低危87例（24．7％），中危171例（48．6％），高危46例（13．1％），未知48例（13．6％）。单体核型16例（4．5％），FLT3-ITD突变阳性41例（11．6％）。首次获骨髓无白血病状态时血细胞恢复程度：CR299例（84．9％），CRp26例（7．4％），CRi27例（7．7％）。存活患者中位随访16（2～94）个月，30个月累积复发（CIR）、无病生存（DFS）和总生存（OS）率分别为47．5％、46．0％和58．6％。多因素分析显示，骨髓无白血病状态时血细胞恢复不良是影响患者CIR、DFS和OS的共同不利因素（HR=1．4，95％C11．0～1．9，P=0．037；HR=I．5，95％CI1．1-2．0，P=0．003；HR=1．5，95％CI1．1～2．0，P=0．017）。此外，SWOG分组危险度高和FLT3-ITD突变阳性是影响患者CIR、DFS和OS的共同不利因素；确诊时外周血原始细胞比例高是影响患者DFS的不利因素；年龄大和确诊时骨髓原始细胞比例高是影响患者OS的不利因素。结论持续化疗的成人AML患者，首次获骨髓无白血病状态时血细胞恢复程度是影响预后的独立因素。Objective To explore prognostic significance of blood count at the time of achieving first morphologic leukemiafree state [ complete remission （CR, ANC ≥ 1 × 10^9/L and PLT≥ 100 × 10^9/L）, CR with incomplete PLT recovery （CRp） and CR with incomplete ANC and PLT recovery （CRi） ] in adult patients with de novo acute myeloid leukemia （AML）. Methods From January 2008 to February 2016, data of consecutive newly-diagnosed AML （non-APL） adults who received continuous chemotherapy in our hospital were analyzed retrospectively. Results 352 patients were included in the study. 179 （50.9%） were male. Median age was 44 （17-65） years. Using the SWOG cytogenetic classification, 87 （24.7%）, 171 （48.6%）, 46 （13.1%） and 48 （13.6%） patients belonged to favorable, intermediate, unfavorable and unknown categories, respectively. 16 （4.5%） had monosomal karyotype and 41 （ 11.6% ） had FLY3- ITD mutation positive. Best response achieved at the time of achieving first morphologic leukemia-free state was CR in 299 （84.9%） patients, CRp in 26 （7.4%） and CRi in 27 （8.1%）. With a median follow-up period of 16 （2-94） months in survivors, the probabilities of cumulative incident of relapse （CIR） rate, disease free survival （DFS） and overall survival （OS） at 30 months were 47.5%, 46.0% and 58.6%, respectively. Multivariate analyses showed that non-CR （CRp or CRi）, was associated with high relapse rate, shorter DFS and OS. In addition, intermediate or high risk of SWOG cytogenetic classification and FLT3-ITD positive were common unfavorable factors affecting CIR, DFS and OS. Peripheral blast 1〉60% at diagnosis was adverse factors affecting DFS. Age≥48 years and bone marrow blasts ≥67% were associated with shorter OS. Conclusion Blood count at the time of achieving morphologic leukemia-free state was one of the key markers associated with treatment outcomes in adults with AML.

关 键 词：白血病 髓系 急性 诱导缓解 血细胞计数 预后 

分 类 号：R733.71[医药卫生—肿瘤]