肿瘤治疗相关骨髓增生异常综合征和急性髓系白血病的临床特征及预后  

Clinical characteristics and prognosis of patients with therapy-related myelodysplastic syndrome and acute myeloid leukemia arising from malignant tumors

作　　者：徐旭升 丁虹[1] 张昕 廖益[1] 李赫 刘钦瑜[1] 刘家卓 张丽[1] 黄杰[1] 龚玉萍[1] 马洪兵[1] 向兵[1] 代阳 侯理[1] 帅晓[1] 牛挺[1] 吴俣[1] Xu Xusheng;Ding Hong;Zhang Xin;Liao Yi;Li He;Liu Qinyu;Liu Jiazhuo;Zhang Li;Huang Jie;Gong Yuping;Ma Hongbing;Xiang Bing;Dai Yang;Hou Li;Shuai Xiao;Niu Ting;Wu Yu(Department of Hematology,West China Hospital,Sichuan University,Chengdu 610041,China;Department of Hematology,Jiujiang First People's Hospital,Jiujiang 332000,China)

机构地区：[1]四川大学华西医院血液内科,成都610041 [2]九江市第一人民医院血液内科,九江332000

出　　处：《中华血液学杂志》2023年第9期742-748,共7页Chinese Journal of Hematology

摘　　要：目的探讨肿瘤治疗相关骨髓增生异常综合征和急性髓系白血病(t-MDS/AML)的临床特征、分子生物学特点、疗效以及预后。方法回顾性分析2010年1月至2023年4月四川大学华西医院86例肿瘤t-MDS/AML患者临床资料,分析肿瘤t-MDS/AML患者的临床特征、分子生物学特点、治疗及其生存情况。结果研究共纳入86例肿瘤t-MDS/AML患者,原发肿瘤类型主要包括乳腺癌(27.9%)、肠癌(17.4%)、淋巴瘤(12.8%)、肺癌(11.6%)。t-AML患者67例,其中M01例、M16例、M227例、M39例、M412例、M510例、M61例、M71例。62例患者可进行遗传学分层,20例(29.9%)低危组患者中位总生存(OS)时间为36(95%CI 22~52)个月;10例(14.9%)中危组患者中位OS时间为6(95%CI 3~9)个月;32例(47.8%)高危患者中位OS时间为8(95%CI 1~15)个月。非低危组t-AML患者中位OS时间为8(95%CI 3~13)个月,明显短于低危组(χ^(2)=13.856,P<0.001);非急性早幼粒细胞白血病(APL)的t-AML低危组患者中位OS时间为27(95%CI 18~36)个月,长于非低危组(Breslow,χ^(2)=5.534,P=0.019),尤其早期OS率差异显著。9例APL病例均按照原发初治APL诱导维持治疗,中位OS时间未达到,1、2、3年OS率分别为100.0%、(75.0±6.2)%、(75.0±6.2)%。58例非APL的t-AML患者中,52例(89.7%)接受化疗,首次诱导化疗完全缓解16例(30.8%)。非APL的t-AML患者的1、2、3年OS率分别为(42.0±6.6)%、(22.9±5.7)%、(13.4±4.7)%。经化疗达到骨髓缓解的患者中位OS时间显著长于未能缓解的患者24(95%CI 18~30)个月对6(95%CI 3~9)个月,(χ^(2)=6.087,P=0.014)。13例患者使用含维奈克拉方案化疗骨髓CR 7例(53.8%),中位OS时间为12(95%CI 9~15)个月,和不含维奈克拉方案化疗对比差异无统计学意义(χ^(2)=2.343,P=0.126)。19例t-MDS患者中,1、2、3年OS率分别为(46.8±11.6)%、(17.5±9.1)%、(11.7±9.1)%,中位OS时间为12(95%CI 7~17)个月,与t-AML相比差异无统计学意义(χ^(2)=0.656,P=0.418)。结论临床上t-MDS/AML的原发肿瘤为乳�Objective To investigate the clinical characteristics,cytogenetics,molecular biology,treatment,and prognosis of patients with therapy-related myelodysplastic syndrome and acute myeloid leukemia(t-MDS/AML)secondary to malignancies.Methods The clinical data of 86 patients with t-MDS/AML in West China Hospital of Sichuan University between January 2010 and April 2023 were retrospectively analyzed.The clinical characteristics,primary tumor types,and tumor-related therapies were analyzed.Results The study enrolled a total of 86 patients with t-MDS/AML,including 67 patients with t-AML,including 1 patient with M0,6 with M1,27 with M2,9 with M3,12 with M4,10 with M5,1 with M6,and 1 with M7.Sixty-two patients could be genetically stratified,with a median overall survival(OS)of 36(95%CI 22–52)months for 20(29.9%)patients in the low-risk group and 6(95%CI 3–9)months for 10(14.9%)in the intermediate-risk group.The median OS time was 8(95%CI 1–15)months in 32(47.8%)patients in the high-risk group.For patients with non-acute promyelocytic leukemia(APL)and AML,the median OS of the low-risk group was 27(95%CI 18–36)months,which was significantly longer than that of the non-low-risk group(χ^(2)=5.534,P=0.019).All 9 APL cases were treated according to the initial treatment,and the median OS was not reached,and the 1-,2-,and 3-year OS rates were 100.0%,(75.0±6.2)%,and(75.0±6.2)%respectively.Of the 58 patients with non-APL t-AML(89.7%),52 received chemotherapy,and 16 achieved complete remission(30.8%)after the first induction chemotherapy.The 1-,2-,and 3-year OS rates of the non-APL t-AML group were(42.0±6.6)%,(22.9±5.7)%,and(13.4±4.7)%,respectively.The median OS of patients who achieved remission was 24(95%CI 18–30)months,and the median OS of those who did not achieve remission was 6(95%CI 3–9)months(χ^(2)=10.170,P=0.001).Bone marrow CR was achieved in 7(53.8%)of 13 patients treated with vineclar-containing chemotherapy,with a median OS of 12(95%CI 9–15)months,which was not significantly different from that of

关 键 词：肿瘤 治疗相关急性髓系白血病 骨髓增生异常综合征 

分 类 号：R551.3[医药卫生—血液循环系统疾病] R733.71[医药卫生—内科学]