80岁以上老年急性髓系白血病33例临床特点及预后分析  

Clinical characteristics and prognosis of 33 acute myeloid leukemia patients aged over 80 years old

作　　者：王明迪[1] 崔海佳 吴道香 马晓彩 胡守奎[2] 高乃姝[2] 余延芳[1] WANG Mingdi;CUI Hai-jia;WU Dao-xiang;MA Xiao-cai;HU Shou-kui;GAO Nai-shu;YU Yan-fang(Department of hematology and clinical laboratory,Peking University ShougangHospital,Beijing 100144,China)

机构地区：[1]北京大学首钢医院血液科,北京100144 [2]北京大学首钢医院检验科,北京100144

出　　处：《中国实用内科杂志》2021年第7期624-628,共5页Chinese Journal of Practical Internal Medicine

基　　金：北京市自然科学基金面上项目(7192240)。

摘　　要：目的探讨80岁以上老年急性髓系白血病(AML)(非急性早幼粒细胞白血病)的临床特点及预后因素。方法回顾性分析2008年1月至2020年3月初诊的年龄≥80岁的33例AML患者临床资料,分析患者临床特征,分析减低剂量化疗组与仅支持治疗组患者的治疗效果、生存时间和影响预后的因素。结果所有患者发病的中位年龄为82(80~91)岁,男女比例1.75∶1,中位总生存期14(1.6~260)周。11例患者有前驱血液疾病史,31例患者诊断时合并慢性基础疾病,化疗组获得部分缓解(PR)及完全缓解(CR)10例。减低剂量化疗组和支持治疗组患者中位总生存期(OS)分别为27周和10周(P=0.001)。单因素分析显示,美国东部肿瘤协作组(ECOG)评分2~4分、综合老年学评估(CGA)脆弱组、白细胞计数≥50×10^(9)/L、有前驱血液病史和仅接受支持治疗为影响患者OS的不良预后因素。多因素分析显示,ECOG评分2~4分、CGA脆弱组、仅接受支持治疗为影响患者OS的独立预后因素。结论 80岁以上老年急性髓系白血病患者预后与多种因素有关,采取减低剂量化疗获得PR及CR者达半数以上,较仅支持治疗有更长的总生存期。Objective To investigate the clinical characteristics and prognosis of acute myeloid leukemia(non-acute promyelocytic leukemia)patients aged over 80 years. Methods Retrospective analysis was performed on the clinical data of 33 patients with acute myeloid leukemia(non-acute promyelocytic leukemia)aged over 80 years in our hospital from January 2008 to March 2020.The therapeutic efficacy,overall survival and the prognostic factors of the patients received low dose chemotherapy were compared with patients received supportive care only. Results The median age of all 33 patients was 82(80-91),the male to female ratio was 1.75∶1,and the median overall survival time was 14(1.6-260)weeks.11 patients had a history of prodromalhematopathy,31 patients were complicated with chronic underling diseases,and 10 patients had achieved partial remission or completeremission.The median overall survival of patients in the reduced dose chemotherapy group and the supportive treatment group were 27 weeks and 10 weeks,the overall survival of the chemotherapy group was significantly longer than that of the supportive treatment group(27 vs. 10 weeks,P=0.001).Univariate analysis showed that ECOG scores of 2-4 points,CGA assessed frail group,WBC≥50 × 109/L,a history of prodromal hematopathyand received supportive treatment were poor prognostic factors for overall survival. According to multivariateanalysis,ECOG scores of 2-4 points,CGA assessed frail group,and only received supportive treatment were independent prognostic factors for overall survival. Conclusion The prognosis of elderly patients with acute myeloid leukemia over the age of 80 was related to multiple factors,more than half of patients who have achieved partial remission or complete remission by using reduced dosechemotherapy have a longer overall survival than onlysupportive treatment.

关 键 词：急性髓系白血病 老年 化疗 支持治疗 

分 类 号：K733.71[历史地理—历史学]