初次骨髓完全缓解时血象恢复不良急性髓系白血病患者临床特征及预后分析  

Clinical features and prognosis of acute myeloid leukemia patients with incomplete blood recovery at the time of achieving morphologic complete remission

作　　者：张澍 李延娟 陈丹丹[1] 陈黎[1] 孙玲[1] Zhang Shu;Li Yanjuan;Chen Dandan;Chen Li;Sun Ling(Department of Hematology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou University Hematology Institute,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院血液科 郑州大学血液病研究所,450052

出　　处：《白血病．淋巴瘤》2018年第6期330-335,共6页Journal of Leukemia & Lymphoma

摘　　要：目的 探讨初次骨髓完全缓解（CR）时血象恢复不良[血小板计数（Plt）〈100×10^9/L或中性粒细胞绝对值（ANC）〈1.0×10^9/L]急性髓系白血病（AML）患者的临床特征和预后因素.方法 回顾性分析2010年1月至2015年9月郑州大学第一附属医院血液科收治的302例初次骨髓CR的AML患者（M3除外）病例资料,根据初次获骨髓CR时血象恢复情况分为血象CR组（Plt≥100×10^9/L且ANC≥1.0×10^9/L）和血象未达CR组（Plt〈100×10^9/L或ANC〈1.0×10^9/L）,比较两组患者临床特征和预后差异,并通过单因素和多因素分析对血象未达CR的AML患者复发和生存情况进行分析.结果血象CR组216例（71.5%）,血象未达CR组86例（28.5%）,两组年龄、就诊时高白细胞患者比例、外周血原始细胞比例、法美英协作组（FAB）分型、细胞遗传学危险度分层和FLT3-ITD/NPM1基因突变比较差异均无统计学意义（均P〉0.05）.血象CR组就诊时骨髓原始细胞数和首疗程化疗获骨髓CR比例高于血象未达CR组（均P〈0.05）,初次骨髓CR时微小残留病（MRD）阳性比例低于血象未达CR组（P=0.004）,且初次骨髓CR时血象CR组骨髓增生程度更活跃（P=0.001）.血象CR组3年复发率低于血象未达CR组（P=0.003）,总生存（OS）率和无病生存（DFS）率高于血象未达CR组（P=0.002,P=0.040）.多因素分析显示,对于血象未达CR的AML患者,高危染色体核型、诱导疗程数≥2个、初次骨髓CR时外周血中性粒细胞未恢复是复发率、OS率和DFS率的共同独立危险因素（均P〈0.05）.FLT3-ITD基因突变阳性是OS率的独立危险因素（P〈0.001）,就诊时外周血原始细胞比例≥0.60是DFS率的独立危险因素（P=0.047）.结论 初次骨髓CR时血象未达CR的AML患者预后较差,且高危染色体核型、诱导疗程数≥2个、中性粒细胞恢复不良者可能预后更差,应视为高危人群,考虑更积极的治疗.Objective To analyze the clinical features and prognosis of acute myeloid leukemia （AML） patients with incomplete blood recovery [platelet count （Plt） 〈 100 ×10^9/L or absolute neutrophil count （ANC）〈1.0×10^9/L] at the first time of achieving morphologic complete remission（CR）. Methods The clinical data of 302 AML patients （non-M3） who were treated at the First Affiliated Hospital of Zhengzhou University from January 2010 to September 2015 were retrospectively reviewed. They were divided into CR group （Plt≥100×10^9/L and ANC≥1.0×10^9/L） and CR with incomplete blood recovery group （Plt〈100×10^9/L or ANC〈1.0 ×10^9/L） according to the condition of blood count at the first time of achieving morphologic CR. The clinical features and prognostic differences between the two groups were compared, and univariate analysis and mutivariate analysis were performed to compare the recurrence and survival of AML with incomplete blood recovery. Results Two hundred and sixteen （71.5%） patients were in CR group and 86 （28.5%） were in CR with incomplete blood recovery group. There was no statistically difference between the two groups in terms of age, high white blood cell, peripheral blasts ratio, France-American-Britain （FAB） type, cytogenetic risk classification and FLT3-ITD/NPM1 gene mutation （all P〉0.05）. Bone marrow blasts before therapy and the proportion of bone marrow CR in the first course of chemotherapy in CR group were higher than those in CR with incomplete blood recovery group （both P〈 0.05）, and the proportion of minimal residual disease （MRD） positive patients was lower in CR group （P=0.004）. Bone marrow proliferation at the time of achieving morphologic CR was more active in CR group （P=0.001）. The 3-year relapse rate in CR group was lower than that in CR with incomplete blood recovery group （P= 0.003）, and overall survival （OS） rate and disease-free survival （DFS） rate were higher than those in CR with incomplete blood rec

关 键 词：白血病 髓样 急性 血细胞计数 预后 

分 类 号：R733.71[医药卫生—肿瘤]