中华儿科杂志
中華兒科雜誌
중화인과잡지
Chinese Journal of Pediatrics
2011年
3期
175-180
,共6页
徐应永%陈静%薛惠良%汤静燕%潘慈%江华%叶启东%罗长缨%周敏%顾龙君
徐應永%陳靜%薛惠良%湯靜燕%潘慈%江華%葉啟東%囉長纓%週敏%顧龍君
서응영%진정%설혜량%탕정연%반자%강화%협계동%라장영%주민%고룡군
白血病,单核细胞,急性%造血干细胞移植%治疗效果%儿童
白血病,單覈細胞,急性%造血榦細胞移植%治療效果%兒童
백혈병,단핵세포,급성%조혈간세포이식%치료효과%인동
Leukemia,monocytic,acute%Hematopoietic stem cell transplantation%Treatment outcome%Child
目的 评估儿童急性单核细胞性白血病(AML-M5)的疗效,探讨异基因造血干细胞移植(allo-HSCT)治疗儿童AML-M5的指征.方法 对AML-M5患儿进行回顾性分析,与同期非AML-M5的AML进行比较,采用Kaplan-Meier曲线评估患儿的无事件生存(EFS)率和总生存(OS)率,COX回归模型评估预后因素.结果 ①75例AML-M5患儿中12例放弃治疗;63例纳入分析,其中2例化疔第2天死亡,61例患儿2个疗程完全缓解(CR)率为73.8%(45例),5年EFS为(34.5±6.8)%,与同期117例非AML-M5、非急性早幼粒细胞性白血病(AML-M3)的AML患儿(51.0±4.9)%的5年EFS相比差异有统计学意义(P＜0.01).②多因素分析显示患儿年龄≥10岁、1疗程后骨髓原幼稚细胞比例≥15%、2疗程后未CR是独立危险因素.③20例1疗程后骨髓原幼稚细胞比例≥15%的AML-M5患儿选择allo-HSCT者(n=5)预后优于单纯化疗者(n=15)[(60.0±21.9)%vs.(7.3±7.1)%,P=0.024].结论 AML-M5患儿预后明显差于其他AML;化疗1疗程后骨髓原幼稚细胞比例≥15%患儿选择allo-HSCT能明显提高生存率;目前依据尚不足以提示1疗程后骨髓原幼稚细胞比例＜15%患儿应选择非血缘相关供体移植治疗.
目的 評估兒童急性單覈細胞性白血病(AML-M5)的療效,探討異基因造血榦細胞移植(allo-HSCT)治療兒童AML-M5的指徵.方法 對AML-M5患兒進行迴顧性分析,與同期非AML-M5的AML進行比較,採用Kaplan-Meier麯線評估患兒的無事件生存(EFS)率和總生存(OS)率,COX迴歸模型評估預後因素.結果 ①75例AML-M5患兒中12例放棄治療;63例納入分析,其中2例化疔第2天死亡,61例患兒2箇療程完全緩解(CR)率為73.8%(45例),5年EFS為(34.5±6.8)%,與同期117例非AML-M5、非急性早幼粒細胞性白血病(AML-M3)的AML患兒(51.0±4.9)%的5年EFS相比差異有統計學意義(P＜0.01).②多因素分析顯示患兒年齡≥10歲、1療程後骨髓原幼稚細胞比例≥15%、2療程後未CR是獨立危險因素.③20例1療程後骨髓原幼稚細胞比例≥15%的AML-M5患兒選擇allo-HSCT者(n=5)預後優于單純化療者(n=15)[(60.0±21.9)%vs.(7.3±7.1)%,P=0.024].結論 AML-M5患兒預後明顯差于其他AML;化療1療程後骨髓原幼稚細胞比例≥15%患兒選擇allo-HSCT能明顯提高生存率;目前依據尚不足以提示1療程後骨髓原幼稚細胞比例＜15%患兒應選擇非血緣相關供體移植治療.
목적 평고인동급성단핵세포성백혈병(AML-M5)적료효,탐토이기인조혈간세포이식(allo-HSCT)치료인동AML-M5적지정.방법 대AML-M5환인진행회고성분석,여동기비AML-M5적AML진행비교,채용Kaplan-Meier곡선평고환인적무사건생존(EFS)솔화총생존(OS)솔,COX회귀모형평고예후인소.결과 ①75례AML-M5환인중12례방기치료;63례납입분석,기중2례화정제2천사망,61례환인2개료정완전완해(CR)솔위73.8%(45례),5년EFS위(34.5±6.8)%,여동기117례비AML-M5、비급성조유립세포성백혈병(AML-M3)적AML환인(51.0±4.9)%적5년EFS상비차이유통계학의의(P＜0.01).②다인소분석현시환인년령≥10세、1료정후골수원유치세포비례≥15%、2료정후미CR시독립위험인소.③20례1료정후골수원유치세포비례≥15%적AML-M5환인선택allo-HSCT자(n=5)예후우우단순화료자(n=15)[(60.0±21.9)%vs.(7.3±7.1)%,P=0.024].결론 AML-M5환인예후명현차우기타AML;화료1료정후골수원유치세포비례≥15%환인선택allo-HSCT능명현제고생존솔;목전의거상불족이제시1료정후골수원유치세포비례＜15%환인응선택비혈연상관공체이식치료.
Objective To evaluate the outcomes of childhood acute monocytic leukemia (AML-M5) and explore the indications of allogeneic hematopoietic stem cell transplantation (allo-HSCT) for children with AML-M5. Method Seventy-five AML-M5 patients and 201 non-AML-M5 AML patients were enrolled in this retrospective analysis. Event-free survival (EFS) and overall survival (OS) rates were estimated by Kaplan-Meier method and prognostic factors were evaluated by COX regression with SPSS.Result ①Twelve patients gave up treatment after confirmed diagnosis. Two patients died on the second day after chemotherapy. Of the 61 patients, 73. 8％ (45/61) achieved complete remission (CR) after two courses of chemotherapy. The 5-year EFS rate was 34. 5％ ±6. 8％. But of the 117 non-AML-M5/M3 AML patients,the 5-year EFS rate was 51.0％ ±4. 9％. ② Multivariate analysis showed that age ≥ 10 y, the proportion of bone marrow blast cell counts≥ 15％ after the first induction therapy, not CR after two courses of chemotherapy were risk factors for the long-term prognosis. ③ Of the 20 patients whose bone marrow blast cell counts≥ 15％ after the first induction therapy, 5 patients who choose allo-HSCT had a better OS than the other 15 patients who choose chemotherapy only ( 60. 0％ ± 21.9％ vs. 7. 3％ ± 7. 1％, P = 0. 024 ).Conclusion Children with AML-M5 had a poorer prognosis than the other AML patients; patients whose bone marrow blast cell counts ≥ 15％ after the first induction therapy chose allo-HSCT had a better prognosis. At present, there is no enough evidence to support that patients whose bone marrow blast cell counts ＜ 15％ after the first induction therapy should choose unrelated donor for allo-HSCT.
