中华内科杂志
中華內科雜誌
중화내과잡지
CHINESE JOURNAL OF INTERNAL MEDICINE
2009年
4期
316-320
,共5页
姜波%秘营昌%林冬%蔡小矜%傅明伟%李巍%王迎%刘旭平%薛艳萍%卞寿庚%王建祥
薑波%祕營昌%林鼕%蔡小矜%傅明偉%李巍%王迎%劉旭平%薛豔萍%卞壽庚%王建祥
강파%비영창%림동%채소긍%부명위%리외%왕영%류욱평%설염평%변수경%왕건상
白血病,髓样,急性%细胞遗传学%预后
白血病,髓樣,急性%細胞遺傳學%預後
백혈병,수양,급성%세포유전학%예후
Leukemia,myeloid,acute%Cytogenetics%Prognosis
目的 评价原发、初治急性髓系白血病(AML)患者诱导治疗后不同时间骨髓幼稚细胞比例对预后的影响.将细胞遗传学与诱导治疗后不同时间骨髓幼稚细胞比例相结合,提出新的AML患者预后分组方法.方法 回顾性分析1999年1月1日至2008年2月1日于我院住院的原发、初治AML患者(非M3型)105例,所有患者在诱导化疗结束时(T1)和(或)骨髓抑制期(T2)进行骨髓穿刺检查.有细胞遗传学资料的患者97例.结果 (1)T1或T2时间点105例行骨髓穿刺检查的患者,骨髓幼稚细胞<0.05者和≥0.05者相比,T1时间点完全缓解(CR)率分别为86.0%、47.4%,3年无复发生存(RFS)率分别为46.2%、21.6%,3年总生存率分别为49.7%、25.6%.T2时间点二者CR率分别为86.3%、41.4%,3年RFS率分别为52.4%、18.9%,3年总生存率分别为61.1%、35.2%,差异均有统计学意义.且T1和,12时间点骨髓幼稚细胞比例具有相关性.(2)将染色体核型预后中等组患者根据T1或T2时间点骨髓幼稚细胞比例分为二组:骨髓幼稚细胞<0.05者和≥0.05者.前者预后与良好组相近,后者预后与不良组相近.(3)多因素分析表明T1或12时间点骨髓幼稚细胞比例是AML患者的独立预后因素.T1时间点骨髓幼稚细胞比例可能较T2时间点骨髓幼稚细胞比例意义更大.结论 以0.05为界,T1或T2时间点骨髓幼稚细胞比例是原发、初治AML患者(非M3型)CR率、RFS、总生存的独立预后因素.将染色体核型与T1和(或)T2时间点骨髓幼稚细胞比例相结合分组,可进一步区分中等组患者,有助于评估预后和选择治疗方案.
目的 評價原髮、初治急性髓繫白血病(AML)患者誘導治療後不同時間骨髓幼稚細胞比例對預後的影響.將細胞遺傳學與誘導治療後不同時間骨髓幼稚細胞比例相結閤,提齣新的AML患者預後分組方法.方法 迴顧性分析1999年1月1日至2008年2月1日于我院住院的原髮、初治AML患者(非M3型)105例,所有患者在誘導化療結束時(T1)和(或)骨髓抑製期(T2)進行骨髓穿刺檢查.有細胞遺傳學資料的患者97例.結果 (1)T1或T2時間點105例行骨髓穿刺檢查的患者,骨髓幼稚細胞<0.05者和≥0.05者相比,T1時間點完全緩解(CR)率分彆為86.0%、47.4%,3年無複髮生存(RFS)率分彆為46.2%、21.6%,3年總生存率分彆為49.7%、25.6%.T2時間點二者CR率分彆為86.3%、41.4%,3年RFS率分彆為52.4%、18.9%,3年總生存率分彆為61.1%、35.2%,差異均有統計學意義.且T1和,12時間點骨髓幼稚細胞比例具有相關性.(2)將染色體覈型預後中等組患者根據T1或T2時間點骨髓幼稚細胞比例分為二組:骨髓幼稚細胞<0.05者和≥0.05者.前者預後與良好組相近,後者預後與不良組相近.(3)多因素分析錶明T1或12時間點骨髓幼稚細胞比例是AML患者的獨立預後因素.T1時間點骨髓幼稚細胞比例可能較T2時間點骨髓幼稚細胞比例意義更大.結論 以0.05為界,T1或T2時間點骨髓幼稚細胞比例是原髮、初治AML患者(非M3型)CR率、RFS、總生存的獨立預後因素.將染色體覈型與T1和(或)T2時間點骨髓幼稚細胞比例相結閤分組,可進一步區分中等組患者,有助于評估預後和選擇治療方案.
목적 평개원발、초치급성수계백혈병(AML)환자유도치료후불동시간골수유치세포비례대예후적영향.장세포유전학여유도치료후불동시간골수유치세포비례상결합,제출신적AML환자예후분조방법.방법 회고성분석1999년1월1일지2008년2월1일우아원주원적원발、초치AML환자(비M3형)105례,소유환자재유도화료결속시(T1)화(혹)골수억제기(T2)진행골수천자검사.유세포유전학자료적환자97례.결과 (1)T1혹T2시간점105례행골수천자검사적환자,골수유치세포<0.05자화≥0.05자상비,T1시간점완전완해(CR)솔분별위86.0%、47.4%,3년무복발생존(RFS)솔분별위46.2%、21.6%,3년총생존솔분별위49.7%、25.6%.T2시간점이자CR솔분별위86.3%、41.4%,3년RFS솔분별위52.4%、18.9%,3년총생존솔분별위61.1%、35.2%,차이균유통계학의의.차T1화,12시간점골수유치세포비례구유상관성.(2)장염색체핵형예후중등조환자근거T1혹T2시간점골수유치세포비례분위이조:골수유치세포<0.05자화≥0.05자.전자예후여량호조상근,후자예후여불량조상근.(3)다인소분석표명T1혹12시간점골수유치세포비례시AML환자적독립예후인소.T1시간점골수유치세포비례가능교T2시간점골수유치세포비례의의경대.결론 이0.05위계,T1혹T2시간점골수유치세포비례시원발、초치AML환자(비M3형)CR솔、RFS、총생존적독립예후인소.장염색체핵형여T1화(혹)T2시간점골수유치세포비례상결합분조,가진일보구분중등조환자,유조우평고예후화선택치료방안.
Objective To evaluate the impact of the percentage of residual blasts in bone marrow at the end of induction chemotherapy ( T1 ) or during myelosuppression phase (T2) on prognosis of de novo acute myeloid leukemia(AML) (non M3) in 105 cases.To refine AML risk-stratification by combining the percentage of residual blast cells (T1 or/and T2) with cytogenetic data based the South West Oncology Group (SWOG) criteria.Methods The data of 105 de novo AML ( non M3 ) patients hospitalized between January 1st 1999 and February 1st 2008 were retrospectively reviewed.Results were analyzed with SPSS15.0 software.Results ( 1 ) Patients were divided into two subgroups by a cutoff of 5% residual bone marrow blasts at T1 or 12 time point.Patients with percentage of residual bone marrow blast cells <5% had better complete remission (CR) rate,relapse-free survival (RFS) and overall survival (OS) than the patients with percentage ≥5% at T1 or T2.The percentage of residual bone marrow blast cells at T1 was correlated with that at T2.(2) The prognosis of patients with intermediate karyotypes with percentage < 5 % at T1 or T2 was similar to that of the patients with favorable karyotypes.The patients with intermediate karyotypes and percentage of residual bone marrow blasts ≥5% at TI or T2 are defined as a subgroup with prognosis similar to that of patients with unfavorable karyotypes.(3) COX regression analysis showed that the percentage of residual bone marrow blasts at T1 or T2 is an independent prognostic factor of AML.The percentage of residual bone marrow blasts at T1 may be more helpful in prognostification than that at T2.Conclusion AML patients with percentage of residual bone marrow blasts < 5% after induction chemotherapy ( T1 or T2) have better CR rate,RFS,OS than the patients with percentage ≥5% at the same time point.Combination of cytogenetics and percentage of residual bone marrow blasts at T1 or T2 is helpful to divide patients with intermediate karyotypes into two subgroups with different prognosis.Thus,a better decision of treatment strategy can be designed.
