老年正常核型急性髓系白血病患者临床特征及预后分析  

Clinical features and prognosis of elderly patients with cytogenetically normal acute myeloid leukemia

作　　者：张知鸷 王卫敏[1] 仵菲斐[1] 甘思林[1] 马杰[1] 刘延方[1] 谢新生[1] 孙玲[1] 万鼎铭[1] 姜中兴[1] 孙慧[1] 

机构地区：[1]郑州大学第一附属医院血液内科,450052

出　　处：《白血病．淋巴瘤》2017年第3期161-165,共5页Journal of Leukemia & Lymphoma

基　　金：国家自然科学基金（81000224）

摘　　要：目的 探讨老年正常核型急性髓系白血病（CN-AML）患者的临床特征及其预后相关因素.方法 回顾性分析104例初治老年CN-AML（M3除外）患者的临床资料.用χ2检验分析完全缓解（CR）的影响因素.用Kaplan-Meier法进行生存分析,并采用Log-rank检验对预后相关影响因素进行单因素分析,采用Cox回归模型进行多因素分析.结果 104例患者中首次化疗后可评价疗效者72例,CR率为38.9%（28/72）,总有效率为55.6%（40/72）.白细胞计数（WBC）〈100×109/L、NPM1突变阳性患者的CR率较高[59.4%（38/64）比12.5%（1/8）,83.3%（10/12）比36.4%（8/22）,均P〈0.05].104例患者中位总生存（OS）时间为6.9个月.单因素分析显示年龄≥70岁、继发AML、高WBC（≥100×109/L）、FLT3-内部串联重复（ITD）突变阳性、CD7阳性、达CR诱导疗程数〉2个以及Charlson合并疾病指数（CCI）评分≥2分的患者OS时间较短（均P〈0.05）.多因素分析显示FLT3-ITD突变阳性（HR=7.61,95%CI 1.80～32.11,P=0.006）及达CR诱导疗程数〉2个（HR=10.11,95%CI 2.38～43.03,P=0.002）是患者OS的独立不良影响因素.结论 老年CN-AML患者的预后是多种因素综合作用的结果,FLT3-ITD突变阳性、 达CR诱导疗程数〉2个是老年CN-AML患者不良OS的独立影响因素.Objective To analyze the clinical characteristics and prognostic factors of elderly patients with cytogenetically normal acute myeloid leukemia （CN-AML）. Methods A total of 104 initial CN-AML patients were enrolled in this retrospective study. The clinical characteristics were collected and analyzed retrospectively. Factors affecting complete remission （CR） were analyzed by using chi square test. Univariate and multivariate analyses of prognostic factors were performed by using Kaplan-Meier and Cox hazard regression model respectively. Results After the first chemotherapy, 72 of 104 patients were able to be evaluated the efficacy, the CR rate was 38.9%（28/72） and total response rate was 55.6%（40/72）. The white cell count〈100 × 109/L and NPM1 mutation were related to a higher CR rate [59.4%（38/64） vs. 12.5%（1/8）, 83.3%（10/12） vs. 36.4%（8/22）, P〈0.05]. Among 104 patients, the median overall survival （OS） was 6.9 months. Univariate analysis results demonstrated that age≥70 years, secondary AML, white cell count≥100×109/L, FLT3-ITD mutation, CD7 expression, achieving CR beyond 2 cycles of induction therapy and CCI score≥2 were influence factors on OS. In multivariable analysis, FLT3-ITD mutation （HR=7.61, 95%CI 1.80-32.11, P= 0.006） and achieving CR beyond 2 cycles of induction therapy （HR= 10.11, 95 % CI 2.38-43.03, P=0.002） were independent prognostic factors for OS in elderly patients with CN-AML. Conclusion The prognosis of elderly patients with CN-AML is the result of the combined effect of many factors, FLT3-ITD mutation and achieving CR beyond 2 cycles of induction therapy are independent prognostic factors in elderly patients with CN-AML.

关 键 词：白血病 髓样 急性 老年人 正常核型 预后 

分 类 号：R733.71[医药卫生—肿瘤]