CAJ | 학술논문

　　目的探讨老年急性早幼粒细胞白血病（APL）与年轻APL患者的临床表现、对治疗反应性及长期生存情况，明确老年患者在现有砷剂联合维甲酸及化疗的治疗模式下的有效性和安全性。方法收集北京大学人民医院血液病研究所的247例APL病例，其中老年组21例、年轻组226例，统计临床资料并分析缓解率、复发率、死亡率、存活时间。结果（1）老年APL在性别、白细胞、血红蛋白、血小板、弥散性血管内凝血（DIC）、中枢神经系统白血病（CNSL）及免疫表型上与年轻患者未见明显差异。（2）老年组完全缓解（CR）率、诱导期死亡率稍优于年轻组（100.0%vs 95.1%，0.0%vs 4.4%），但差异均无统计学意义（P＝0.301，P＝0.325）；复发率及CR期死亡率稍高于年轻组（19.0%vs 16.3%，4.8% vs 1.9%），差异亦无统计学意义（P＝0.744，P＝0.095）。（3）4年、6年和7年总存活率及无事件存活率与年轻组比较均无显著差异（P＞0.05）。结论老年APL与年轻APL在临床特点、对治疗的反应性及长期生存上无明显差异，现有治疗模式对老年患者安全、有效。
　　목적탐토노년급성조유립세포백혈병（APL）여년경APL환자적림상표현、대치료반응성급장기생존정황，명학노년환자재현유신제연합유갑산급화료적치료모식하적유효성화안전성。방법수집북경대학인민의원혈액병연구소적247례APL병례，기중노년조21례、년경조226례，통계림상자료병분석완해솔、복발솔、사망솔、존활시간。결과（1）노년APL재성별、백세포、혈홍단백、혈소판、미산성혈관내응혈（DIC）、중추신경계통백혈병（CNSL）급면역표형상여년경환자미견명현차이。（2）노년조완전완해（CR）솔、유도기사망솔초우우년경조（100.0%vs 95.1%，0.0%vs 4.4%），단차이균무통계학의의（P＝0.301，P＝0.325）；복발솔급CR기사망솔초고우년경조（19.0%vs 16.3%，4.8% vs 1.9%），차이역무통계학의의（P＝0.744，P＝0.095）。（3）4년、6년화7년총존활솔급무사건존활솔여년경조비교균무현저차이（P＞0.05）。결론노년APL여년경APL재림상특점、대치료적반응성급장기생존상무명현차이，현유치료모식대노년환자안전、유효。
Objective To compare the clinical manifestations, response to treatment and long-term survival of acute promyelocytic leukemia(APL) between elderly and young patients, and to determine the efficacy and safety of the all-trans retinoic acid combining arsenic trioxide and chemotherapy for the elderly. Methods Clinical data of 247 patients with APL admitted in our institute from 1992 to 2010 were collected, and retrospectively studied to compare their clinical manifestations, remission, relapse, mortality and survival rate between elderly (with an age of ≥55, n=21) and non-elderly groups (with an age of <55, n=226). Results (1) There was no significant difference between the elderly and non-elderly APL patients in gender, white blood cells, hemoglobin, platelets, disseminated intravascular coagulation (DIC), central nervous system leukemia (CNSL), and immunophenotypes of CD56 and CD117. (2) The rate of complete remission (CR) (100.0%vs 95.1%) and mortality in induction therapy (0.0%vs 4.4%) were a little bit better in the elderly group than the non-elderly group, though without significant difference (P=0.301, P=0.325). But the relapse rate (19.0%vs 16.3%) and death in CR (4.8%vs 1.9%) were higher in elderly APL than in non-elderly group, and there was no significant difference either between them (P=0.744, P=0.095). (3) No obvious difference was found in 4-year, 6-year, and 7-year overall survival rate and event-free survival rates between elderly and non-elderly APL (P>0.05). Conclusions There is no significant difference between the elderly and non-elderly APL in clinical features, response to treatment and long-term survival. So, the efficacy and safety of current treatment are guaranteed for elderly APL patients.