CAJ | 학술논문

目的分析复发难治性急性髓系白血病(AML)患者的临床和遗传学高危因素,评估再诱导方案疗效.方法回顾性分析296例初诊AML患者临床资料,观察其中89例复发难治性AML患者的临床特征,对比不同再诱导化疗方案的疗效.结果与同期收治AML患者相比,初诊时高龄、复杂核型和Fms样酪氨酸激酶3内部串联重复(FLT3-ITD)基因突变是AML复发难治的高危因素(P＜0.05).复发难治性AML患者再诱导有效率(完全缓解率+部分缓解率)为44.90％(35/78).其中使用原方案或无交叉耐药的新药组成联合化疗方案(方案A)再诱导有效率为35.12％(13/37);含中、大剂量阿糖胞苷(Ara-C)方案(方案B)再诱导有效率为61.90％(13/21);由阿柔比星或高三尖杉酯碱、小剂量Ara-C联合粒细胞集落刺激因子(G-CSF)组成的预激方案(方案C)再诱导有效率为45.00％(9/20).方案B再诱导疗效优于方案A,差异具有统计学意义(P＜0.05).结论初诊时高龄、复杂核型和FLT3-ITD基因突变是AML复发难治的重要原因.不同的再诱导方案疗效存在差异,对年轻患者选择含中、大剂量Ara-C方案有助于提高再诱导缓解率.对耐受性差的患者,更适合选择预激方案以提高再诱导缓解率.
목적 분석복발난치성급성수계백혈병(AML)환자적림상화유전학고위인소,평고재유도방안료효.방법 회고성분석296례초진AML환자림상자료,관찰기중89례복발난치성AML환자적림상특정,대비불동재유도화료방안적료효.결과 여동기수치AML환자상비,초진시고령、복잡핵형화Fms양락안산격매3내부천련중복(FLT3-ITD)기인돌변시AML복발난치적고위인소(P＜0.05).복발난치성AML환자재유도유효솔(완전완해솔+부분완해솔)위44.90％(35/78).기중사용원방안혹무교차내약적신약조성연합화료방안(방안A)재유도유효솔위35.12％(13/37);함중、대제량아당포감(Ara-C)방안(방안B)재유도유효솔위61.90％(13/21);유아유비성혹고삼첨삼지감、소제량Ara-C연합립세포집락자격인자(G-CSF)조성적예격방안(방안C)재유도유효솔위45.00％(9/20).방안B재유도료효우우방안A,차이구유통계학의의(P＜0.05).결론 초진시고령、복잡핵형화FLT3-ITD기인돌변시AML복발난치적중요원인.불동적재유도방안료효존재차이,대년경환자선택함중、대제량Ara-C방안유조우제고재유도완해솔.대내수성차적환자,경괄합선택예격방안이제고재유도완해솔.
Objective To analyze clinical and genetic risk factors of refractory or relapsed acute myeloid leukemia (AML) patients,and evaluate the efficacy of reinduction of chemotherapy.Methods 296 newly diagnosed AML patients,including 89 refractory or relapsed cases,were observed with clinical characteristics.And the efficiency of different reinduction chemotherapy regimens were compared.Results Compared with the non-refractory or relapsed AML,age,complex karyotype and Fms like tyrosine kinase 3 internal tandem duplication (FLT3-ITD) gene mutations were risk factors of relapsed or refractory AML (P ＜ 0.05).Seventy-eight refractory and relapsed AML patients received reinduction therapy.The overall response rate (the complete response rate and the partial response rate) was 44.90 ％ (30/78).All reinduction regimens were divided into three categories:using the initial induction scheme or using new induction scheme including some chemotherapeutics without cross-resistance (regimen A),using the induction regimen containing medium-or high-dose cytarabine (regimen B),and using priming regimen containing of G-CSF,cytarabine,aclacinomycin or homoharringtonine (regimen C).Their overall response rate were 35.12 ％ (13/37),61.90 ％ (13/21) and 45.00 ％ (9/20),respectively,in which the overall response rate of regimen B was statistically higher than regimen A (P ＜ 0.05).Conclusions Age,complex karyotype and FLT3-ITD mutation were important causes of relapsed or refractory AML.The overall response rates were different among three different reinduction regimens.It is helpful to improve the overall response rate of reinduction therapy to use the regimen containing medium-or high-dose cytarabine,which was more suitable for young patients.For patients with poor tolerance,the priming regimen suit was more helpful to improve the overall response rate.