去甲氧柔红霉素联合阿糖胞苷治疗初发急性髓系白血病的预后分析  

Outcomes of adult patients with de novo acute myeloid leukemia received idarubicin plus eytarabine regimen as induction chemotherapy

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] 

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》2018年第1期15-21,共7页Chinese Journal of Hematology

摘　　要：目的探讨接受IAl0[去甲氧柔红霉素（IDA）10mg·m-2·d-1×3d联合阿糖胞苷（Ara—C）100mg·m-2·d-1×7d]作为诱导方案且未接受异基因造血干细胞移植（allo．HSCT）的成人急性髓系白血病（AML）患者的预后影响因素。方法回顾2008年1月至2016年2月收治的接受IAl0作为诱导化疗方案、获得形态学无白血病状态（MLFS）后未接受allo—HSCT的198例AML（不包括急性早幼粒细胞白血病）连续病例，分析诊断时特征、首次获得MLFS时血细胞恢复程度、首次获得MLFS时和巩固1个疗程后微小残留病（MRD）水平对预后的影响。结果198例患者中，男96例（48．5％），中位年龄42（18～62）岁。SWOG分组：低危45例（22．7％），中危104例（52．5％），高危24例（12．1％），危险度未知25例（12．6％）。FLT3一ITD突变阳性28例（14．1％）。完全缓解（CR，MLFS伴ANC≥1×109／L和PLT≥100×109／L）168例（84．8％），CRp（MLFS伴PLT未恢复）16例（8．1％），CRi（MLFS伴ANC和PLT均未恢复）14例（7．1％）。131例（66．2％）存活患者中位随访时间15（1～70）个月，2年累积复发率（CIR）、无病生存（DFS）、总生存（OS）率分别为45．2％、46．9％、62．9％，中位复发、DFS、OS时间分别为34、20、37个月。在所有获得MLFS的患者中进行多因素分析，FLT3-ITD突变阳性和CRi是影响患者CIR、DFS、OS的共同不利因素；SWOG危险度为高危是影响患者CIR和DFS的共同不利因素；单体核型是影响患者OS的独立危险因素。分析接受巩固治疗≥1个疗程的患者，FLT3-ITD突变阳性和SWOG危险度为高危是影响患者CIR、DFS、OS的共同不利因素；外周血原始细胞≥0．50和巩固治疗1个疗程后MRD阳性[FCM和（或）WT1 mRNA阳性]是影响患者CIR和DFS的共同不利因素；CRi是影响患者DFS和OS的共同不利因素。结论对于接受IA10作为诱导方案且获得MLFS后未接受allo—HSCT的�Objective To explore outcomes in adult with de novo acute myeloid leukemia （AML） received IA10 （10 mg/m2 dl-3 idarubicin plus cytarabine 100 mg/m2 dl-7） regimen as induction chemotherapy. Methods From January 2008 to February 2016, data of consecutive newly-diagnosed AML （non-M3） adults treated with ]A10 who achieved morphologic leukemia-free state （MLFS） but not accepted allogeneic hematopoietic stem cell transplantation （allo-HSCT） were assessed retrospectively. Results A total of 198 patients were included in this study with 96 （48.5%） male and a median age of 42 years old （range, 18-62 years old）. Using the SWOG cytogenetic classification, 45 （22.7%）, 104 （52.5%）, 24 （12.1%） and 25 （12.6%） patients belonged to favorable, intermediate, unfavorable and unknown categories, respectively. 6 （3.0%） patients had monosomal karyotype, and 28 （14.1%） positive FLT3-ITD mutation. A complete remission （CR, defined as MLFS with ANC ≥1×109/L and PLT ≥1×109/L） achieved in 168 （84.8%） patients, a CRp （defined as MLFS with incomplete PLT recovery） in 16 （8.1%） and a CRi （defined as MLFS with incomplete ANC and PLT recovery） in 14 （7.1%）. With a median follow- up period of 15 months （range, 1 to 70 months） in survivors, the probabilities of cumulative incident of relapse （CIR）, disease free survival （DFS） and overall survival （OS） rates at 2-year were 45.2%, 46.9% and 62.9%, respectively; the median durations of relapse, DFS and OS were 34, 20 and 37 months respectively. At the time of achieving first MLFS, multivariate analyses showed that positive FLT3-ITD mutation and CRi were common adverse factors affecting CIR, DFS and OS; unfavorable-risk of SWOG criteria was an adverse factor affecting CIR and DFS; monosomal karyotype was associated with shorter OS. After first consolidation therapy, FLT3-ITD mutation positive and unfavorable-risk of SWOG criteria had negatively impact on CIR, DFS and OS; peripheral blasts 1〉 0.50 and pos

关 键 词：白血病 髓样 急性 去甲氧柔红霉素 预后 

分 类 号：R733.71[医药卫生—肿瘤]