中华血液学杂志
中華血液學雜誌
중화혈액학잡지
Chinese Journal of Hematology
2011年
5期
294-298
,共5页
张静%秘营昌%王迎%刘兵城%林冬%李巍%刘凯奇%王慧君%刘旭萍%卞寿庚%王建祥
張靜%祕營昌%王迎%劉兵城%林鼕%李巍%劉凱奇%王慧君%劉旭萍%卞壽庚%王建祥
장정%비영창%왕영%류병성%림동%리외%류개기%왕혜군%류욱평%변수경%왕건상
白血病,单核细胞,急性%治疗%预后
白血病,單覈細胞,急性%治療%預後
백혈병,단핵세포,급성%치료%예후
Leukaemia,monocytic,acute%Therapy%Prognosis
目的 分析(m)HAD方案诱导治疗急性单核细胞白血病(AMOL)的疗效及染色体核型对预后的影响.方法 对79例用(m)HAD方案诱导治疗的AMOL患者临床资料进行回顾性分析.(m)HAD方案具体为高三尖杉酯碱2 mg/m2,第1～7天;阿糖胞苷100 mg/m2,第1～7天,部分患者于第5、6、7天改为1.5 g·m-2·(12 h)-1;柔红霉素40 mg/m2,第1～3天.结果 ①诱导化疗完全缓解(CR)率79.7%(79例中63例),部分缓解(PR)率6.3%(79例中5例),总有效率86.0%.②对75例患者进行染色体核型分析,正常核型43例,异常核型30例,未见分裂象2例;预后中等组49例,预后差组18例,意义未知组6例.核型正常者CR率及1年、3年总体生存(OS)率明显高于核型异常者(P<0.05);但两组在无病生存(DFS)方面差异无统计学意义(P>0.05).染色体核型预后中等组患者CR率85.7%,1年、3年OS率分别为75.9%、65.4%,DFS率分别为82.2%、77.9%,均明显好于预后差组(CR率61.1%,1年、3年0s率分别为51.3%、25.6%;1年、3年DFS率分别为66.7%、26.7%)(P<0.05).③COX多因素分析显示,染色体核型、巩固治疗疗程数对生存有显著的影响.结论 采用(m)HAD方案诱导治疗AMOL患者,CR率高,缓解后巩固治疗是否充分明显影响患者的预后.AMOL患者异常核型发生率和既往报道的急性髓系白血病群体发生率相似,且染色体核型同样与预后密切相关,预后中等组明显优于预后差组.
目的 分析(m)HAD方案誘導治療急性單覈細胞白血病(AMOL)的療效及染色體覈型對預後的影響.方法 對79例用(m)HAD方案誘導治療的AMOL患者臨床資料進行迴顧性分析.(m)HAD方案具體為高三尖杉酯堿2 mg/m2,第1～7天;阿糖胞苷100 mg/m2,第1～7天,部分患者于第5、6、7天改為1.5 g·m-2·(12 h)-1;柔紅黴素40 mg/m2,第1～3天.結果 ①誘導化療完全緩解(CR)率79.7%(79例中63例),部分緩解(PR)率6.3%(79例中5例),總有效率86.0%.②對75例患者進行染色體覈型分析,正常覈型43例,異常覈型30例,未見分裂象2例;預後中等組49例,預後差組18例,意義未知組6例.覈型正常者CR率及1年、3年總體生存(OS)率明顯高于覈型異常者(P<0.05);但兩組在無病生存(DFS)方麵差異無統計學意義(P>0.05).染色體覈型預後中等組患者CR率85.7%,1年、3年OS率分彆為75.9%、65.4%,DFS率分彆為82.2%、77.9%,均明顯好于預後差組(CR率61.1%,1年、3年0s率分彆為51.3%、25.6%;1年、3年DFS率分彆為66.7%、26.7%)(P<0.05).③COX多因素分析顯示,染色體覈型、鞏固治療療程數對生存有顯著的影響.結論 採用(m)HAD方案誘導治療AMOL患者,CR率高,緩解後鞏固治療是否充分明顯影響患者的預後.AMOL患者異常覈型髮生率和既往報道的急性髓繫白血病群體髮生率相似,且染色體覈型同樣與預後密切相關,預後中等組明顯優于預後差組.
목적 분석(m)HAD방안유도치료급성단핵세포백혈병(AMOL)적료효급염색체핵형대예후적영향.방법 대79례용(m)HAD방안유도치료적AMOL환자림상자료진행회고성분석.(m)HAD방안구체위고삼첨삼지감2 mg/m2,제1～7천;아당포감100 mg/m2,제1～7천,부분환자우제5、6、7천개위1.5 g·m-2·(12 h)-1;유홍매소40 mg/m2,제1～3천.결과 ①유도화료완전완해(CR)솔79.7%(79례중63례),부분완해(PR)솔6.3%(79례중5례),총유효솔86.0%.②대75례환자진행염색체핵형분석,정상핵형43례,이상핵형30례,미견분렬상2례;예후중등조49례,예후차조18례,의의미지조6례.핵형정상자CR솔급1년、3년총체생존(OS)솔명현고우핵형이상자(P<0.05);단량조재무병생존(DFS)방면차이무통계학의의(P>0.05).염색체핵형예후중등조환자CR솔85.7%,1년、3년OS솔분별위75.9%、65.4%,DFS솔분별위82.2%、77.9%,균명현호우예후차조(CR솔61.1%,1년、3년0s솔분별위51.3%、25.6%;1년、3년DFS솔분별위66.7%、26.7%)(P<0.05).③COX다인소분석현시,염색체핵형、공고치료료정수대생존유현저적영향.결론 채용(m)HAD방안유도치료AMOL환자,CR솔고,완해후공고치료시부충분명현영향환자적예후.AMOL환자이상핵형발생솔화기왕보도적급성수계백혈병군체발생솔상사,차염색체핵형동양여예후밀절상관,예후중등조명현우우예후차조.
Objective To analyze the treatment outcome and impact of cytogenetic abnormalities on the response and survival of acute monocytic leukaemia (AMOL) patients received (m)HAD regimen as induction chemotherapy. Methods Seventy-nine AMOL patients were treated with (m) HAD regimen as induction therapy ( HHT 2 mg/m2, d 1-7; Ara-C 100 mg/m2,d 1-7 and increasing to 1. 5 g · m-2 ·(12h)-1,d5-7 in some patients; DNR 40 mg/m2, d 1 - 3). The treatment outcome and prognostic factors were analyzed. Results ①The complete remission( CR) rate was 79.7% (63/79), partial remission (PR)rate was 6.3% (5/79) ,overall rate was 86.0%. ②The chromosome karyotypes were analyzed in 75 patients,of whom 43 with normal karyotypes (NCR) and 30 abnormal karyotypes ( ACR). For the cytogenetic prognostic groups, 49 patients were intermediate, 18 poor and 6 unknown. The CR,1-year and 3-year overal survival (OS)rates in NCR group were significantly higher than those in ACR group(P <0.05);but there was no significantly statistical difference in disease free survival ( DFS) between the two groups (P > 0. 05). The CR,1-year OS 、3-year OS and 1-year DFS and 3-year DFS rates in intermediate prognostic group were significantly higher than those in poor prognostic group (85. 7% vs 61. 1% , 75. 9% vs 51. 3% , 65. 4% vs 25. 6% ,82.2% vs 66.7% , and 77. 9% vs 26. 7% , respectively) ( P < 0. 05). ③Chromosome karyotype and the number of consolidation therapy courses had more important influence on survival in COX analysis. Conclusion (m)HAD regimen as induction chemotherapy for AMOL patients achieves a high CR rate. It has an important influence on survival for the patients to reveive adequate consolidation therapy. The frequency of cytogenetic abnormalities in AMOL is similar to that in other AMLs. The prognosis of AMOL patients with chromosome karyotype in intermediate prognostic group is significantly better than that in poor prognostic group.
