外周血淋巴细胞早期恢复在IA诱导治疗初治AML患者预后中的临床意义  

The role of absolute lymphocyte count recovery after IA regimen in survival in patients newly diagnosed with acute myeloid leukemia

作　　者：李砚如 刘为星[1,2] 朱雨[1] 洪鸣[1] 谢月[1] 赵慧慧[1] 朱晗[1] 李骥[3] 钱思轩[1] 

机构地区：[1]南京医科大学第一附属医院,江苏省人民医院血液科,南京210029 [2]南京医科大学附属江宁医院急诊科 [3]西藏自治区人民医院内科

出　　处：《临床血液学杂志》2017年第2期190-193,共4页Journal of Clinical Hematology

基　　金：国家自然科学基金(No:81570134;81270614;81300379)

摘　　要：目的:探讨外周血淋巴细胞绝对计数(ALC)与IA方案即标准剂量的去甲氧柔红霉素(IDA)联合阿糖胞苷(Ara-C)诱导治疗初治急性髓系白血病(AML)(除外急性早幼粒细胞白血病)患者预后的关系。方法:155例初治AML患者均接受IA方案诱导治疗:IDA 10~12mg/(m^2·d),第1~3天,Ara-C 100mg/(m^2·d),持续静脉滴注第1~7天。126例IA诱导治疗达完全缓解(CR)患者的后继治疗包括:70例采用以大剂量Ara-C为主的化疗;32例行自体干细胞移植(auto-HSCT);24例行异基因造血干细胞移植(allo-HSCT)。回顾性分析诱导治疗后第10天ALC(ALC-10)、第14天ALC(ALC-14)与总生存时间(OS)、无复发生存时间(RFS)的关系。结果:首次诱导治疗后,5例(3.2%)发生早期死亡,其余150例进行疗效评估,其中126例(84.0%)达到CR,9例(6.0%)获得部分缓解。ALC-10≥0.435×10~9/L者与ALC-10<0.435×10~9/L者中位OS分别为13.6个月、18.5个月(P=0.019),前者中位RFS优于后者(13.6个月∶10.0个月,P=0.007);ALC-14≥0.270×10~9/L者与ALC-14<0.270×10~9/L者中位OS分别为14.8个月、17.0个月(P=0.002),前者中位RFS优于后者(11.8个月∶10.0个月,P=0.002)。多因素分析显示,ALC-14是影响RFS的独立危险因素。在以大剂量Ara-C为主的化疗组和auto-HSCT组,ALC-14≥0.270×10~9/L者与ALC-14<0.270×10~9/L者相比,RFS均明显延长(P=0.025、0.028)。在allo-HSCT组,ALC-14对RFS的影响无统计学意义。结论:ALC-14可以作为判断IA方案诱导治疗初治AML患者预后的指标,尤其是CR后接受以大剂量Ara-C为主的化疗和auto-HSCT患者。Objective：To analyze the significance of absolute lymphocyte count （ALC） recovery in newly diagnosed acute myeloid leukemia （AML） patients after IA regimen. Method： A total of 155 newly diagnosed AML patients received IDA （10 to 12 mg/m^2 ,days 1 to 3） and continuous infusion Ara-C （100 mg/mz ,days 1 to 7）. ALC recovery was studied at day 10 （ALC-10） and day 14 （ALC-14） after IA regimen. Follow-up treatment of 126 patients with complete remission （CR） after initial induction therapy included： 70 casess received high-dose Ara-C- based chemotherapy,32 cases underwent autologous hematopoietic stem cell transplantation （auto-HSCT）,and 24 cases underwent allogenie hematopoietic stem cell transplantation （allo-HSCT）. We analyzed the impact of ALC- 10, ALC-14 on overall survival （OS） and relapse-flee survival （RFS）. Result：Five patients had early death after in- itial induction,126 （84.0%） patients achieved CR,and 9 （6.0%） patients achieved partial remission. The relation-ship between ALC-10, ALC-14 and OS and RFS was assessed in 150 patients. The median OS of ALC-10 ≥0. 435×10^9/L and ALC-10%0. 435×10^9/L were 13.6 months,18.5 months （P=0. 019）. Superior RFS was observed in patients with an ALC-10 90. 435×10^9/L （13.6 months vs. 10.0 months,P=0. 007）. The median OS of ALC-14 90. 270X 109/L and ALC-14〈0. 270×10^9/L were 14. 8 months, 17.0 months （P=0. 002）. Patients with an ALC-14 90. 270×10^9/L had superior RFS （11.8 months vs. 10.0 months, P= 0. 002）. Multivariate analysis demonstrated ALC-14 to be independent prognostic factors for survival. Additionally, for patients undergoing high-dose Ara-C-based chemotherapy and auto-HSCT,an ALC-14≥0. 270×10^9/L also had superior RFS （P=0.025, P=0. 028, respectively）. In the allo-HSCT group, the effect of ALC-14 on RFS was not statistically significant. Conclusion： ALC-14 could be used to predict outcome in newly diagnosed AML patients after IA regimen,especially for CR patients receivi

关 键 词：白血病 髓系 急性 淋巴细胞绝对计数 预后 

分 类 号：R738.71[医药卫生—肿瘤]