国际输血及血液学杂志
國際輸血及血液學雜誌
국제수혈급혈액학잡지
INTERNATIONAL JOURNAL OF BLOOD TRANSFUSION AND HEMATOLOGY
2015年
4期
293-299
,共7页
程玮%刘辉%裴蕾%宁尚勇%李江涛%范芸%冯茹%张野坪%田园
程瑋%劉輝%裴蕾%寧尚勇%李江濤%範蕓%馮茹%張野坪%田園
정위%류휘%배뢰%저상용%리강도%범예%풍여%장야평%전완
白血病,髓样,急性%老年人%诱导化疗%早期死亡率%预后
白血病,髓樣,急性%老年人%誘導化療%早期死亡率%預後
백혈병,수양,급성%노년인%유도화료%조기사망솔%예후
Leukemia,myeloid,acute%Aged%Induction chemotherapy%Early death rate%Prognosis
目的 探讨老年急性髓细胞白血病(AML)患者的临床特点及影响预后的因素,为其个体化治疗提供依据.方法 回顾性分析2003年1月至2013年12月于北京医院血液科收治的92例年龄≥60岁初治老年AML患者的临床病历资料,其中74例接受诱导缓解化疗方案治疗,纳入化疗组;12例接受姑息治疗,纳入姑息治疗组.比较两组患者的疗效及预后差异,并对患者预后及早期死亡[总生存(OS)期≤8周]率影响因素均进行单因素和多因素分析.两组患者年龄,性别构成比,AML法国、美国和英国(FAB)分型及体力状态(PS)评分等基线资料比较,差异均无统计学意义(P＞0.05).结果 ①化疗组患者中位OS期为8.0个月(0.1～175.0个月),显著长于姑息治疗组患者的2.3个月(0.1～14.0个月),且差异有统计学意义(x2=9.558,P=0.002).化疗组患者中,65例患者可评价疗效,其中达完全缓解(CR)为28例(43.1％),达CR者的中位OS期(28.4个月)显著长于未达CR者(6.0个月),且差异有统计学意义(x2 =92.048,P=0.000).本组92例老年AML患者的1年OS率为29.3％(27/92),3年OS率为9.8％(9/92).②年龄、PS评分、白细胞计数、血清乳酸脱氢酶(LDH)水平、染色体核型及染色体单体核型(MK)均与患者预后相关(P＜0.05).多因素分析结果显示,PS评分≥3分、白细胞计数≥100.0×109/L、血清LDH水平/正常值≥2倍及MK均是影响老年AML患者预后的独立危险因素(RR=5.076,11.263,2.297,5.076;P＜0.05).③本组92例老年AML患者中,早期死亡21例(22.8％).化疗组患者早期死亡率为17.6％(13/74),与姑息组患者的41.7％(5/12)比较,差异无统计学意义(x2=2.314,P=0.128).对老年AML患者早期死亡率影响因素进行分析发现,与年龄、PS评分、白细胞计数、血清肌酐水平、血清LDH水平有关(P＜0.05).多因素分析结果显示,年龄≥80岁与白细胞计数≥100.0×109/L是影响老年AML患者早期死亡率的独立危险因素(OR=0.256,0.158;P＜0.05).结论 应根据临床及生物学特点进行预后分层,给予个体化治疗.
目的 探討老年急性髓細胞白血病(AML)患者的臨床特點及影響預後的因素,為其箇體化治療提供依據.方法 迴顧性分析2003年1月至2013年12月于北京醫院血液科收治的92例年齡≥60歲初治老年AML患者的臨床病歷資料,其中74例接受誘導緩解化療方案治療,納入化療組;12例接受姑息治療,納入姑息治療組.比較兩組患者的療效及預後差異,併對患者預後及早期死亡[總生存(OS)期≤8週]率影響因素均進行單因素和多因素分析.兩組患者年齡,性彆構成比,AML法國、美國和英國(FAB)分型及體力狀態(PS)評分等基線資料比較,差異均無統計學意義(P＞0.05).結果 ①化療組患者中位OS期為8.0箇月(0.1～175.0箇月),顯著長于姑息治療組患者的2.3箇月(0.1～14.0箇月),且差異有統計學意義(x2=9.558,P=0.002).化療組患者中,65例患者可評價療效,其中達完全緩解(CR)為28例(43.1％),達CR者的中位OS期(28.4箇月)顯著長于未達CR者(6.0箇月),且差異有統計學意義(x2 =92.048,P=0.000).本組92例老年AML患者的1年OS率為29.3％(27/92),3年OS率為9.8％(9/92).②年齡、PS評分、白細胞計數、血清乳痠脫氫酶(LDH)水平、染色體覈型及染色體單體覈型(MK)均與患者預後相關(P＜0.05).多因素分析結果顯示,PS評分≥3分、白細胞計數≥100.0×109/L、血清LDH水平/正常值≥2倍及MK均是影響老年AML患者預後的獨立危險因素(RR=5.076,11.263,2.297,5.076;P＜0.05).③本組92例老年AML患者中,早期死亡21例(22.8％).化療組患者早期死亡率為17.6％(13/74),與姑息組患者的41.7％(5/12)比較,差異無統計學意義(x2=2.314,P=0.128).對老年AML患者早期死亡率影響因素進行分析髮現,與年齡、PS評分、白細胞計數、血清肌酐水平、血清LDH水平有關(P＜0.05).多因素分析結果顯示,年齡≥80歲與白細胞計數≥100.0×109/L是影響老年AML患者早期死亡率的獨立危險因素(OR=0.256,0.158;P＜0.05).結論 應根據臨床及生物學特點進行預後分層,給予箇體化治療.
목적 탐토노년급성수세포백혈병(AML)환자적림상특점급영향예후적인소,위기개체화치료제공의거.방법 회고성분석2003년1월지2013년12월우북경의원혈액과수치적92례년령≥60세초치노년AML환자적림상병력자료,기중74례접수유도완해화료방안치료,납입화료조;12례접수고식치료,납입고식치료조.비교량조환자적료효급예후차이,병대환자예후급조기사망[총생존(OS)기≤8주]솔영향인소균진행단인소화다인소분석.량조환자년령,성별구성비,AML법국、미국화영국(FAB)분형급체력상태(PS)평분등기선자료비교,차이균무통계학의의(P＞0.05).결과 ①화료조환자중위OS기위8.0개월(0.1～175.0개월),현저장우고식치료조환자적2.3개월(0.1～14.0개월),차차이유통계학의의(x2=9.558,P=0.002).화료조환자중,65례환자가평개료효,기중체완전완해(CR)위28례(43.1％),체CR자적중위OS기(28.4개월)현저장우미체CR자(6.0개월),차차이유통계학의의(x2 =92.048,P=0.000).본조92례노년AML환자적1년OS솔위29.3％(27/92),3년OS솔위9.8％(9/92).②년령、PS평분、백세포계수、혈청유산탈경매(LDH)수평、염색체핵형급염색체단체핵형(MK)균여환자예후상관(P＜0.05).다인소분석결과현시,PS평분≥3분、백세포계수≥100.0×109/L、혈청LDH수평/정상치≥2배급MK균시영향노년AML환자예후적독립위험인소(RR=5.076,11.263,2.297,5.076;P＜0.05).③본조92례노년AML환자중,조기사망21례(22.8％).화료조환자조기사망솔위17.6％(13/74),여고식조환자적41.7％(5/12)비교,차이무통계학의의(x2=2.314,P=0.128).대노년AML환자조기사망솔영향인소진행분석발현,여년령、PS평분、백세포계수、혈청기항수평、혈청LDH수평유관(P＜0.05).다인소분석결과현시,년령≥80세여백세포계수≥100.0×109/L시영향노년AML환자조기사망솔적독립위험인소(OR=0.256,0.158;P＜0.05).결론 응근거림상급생물학특점진행예후분층,급여개체화치료.
Objective To explore the clinical characteristics and prognostic factors of 92 elderly patients with acute myeloid leukemia (AML).Methods The clinical data of 92 newly diagnosed patients with AML who were older than 60 years old in Department of Hematology,Beijing Hospital from January 2003 to December 2013 were retrospectively analyzed.Among them,74 patients who received induction chemotherapy were included into the chemotherapy group,and 12 patients who received palliative treatment were included into the palliative care group.The efficacy and prognosis were compared between two groups.The influential factors of prognosis and early mortality [overall survival (OS) time≤ 8 weeks] were evaluated by univariate and multivariate analysis.All patients signed the clinical research informed consent.There were no significant differences in the distribution of age,gender ratio,AML French-American-British (FAB) classification and performance status (PS) score between chemotherapy group and palliative care group (P ＞ 0.05).Results ① The median OS time in chemotherapy group was 8.0 months (0.1-175.0 months),which was significantly longer than that in palliative care group 2.3 months (0.1-14.0 months),and the difference was statistically significant (x2=9.558,P =0.002).In the chemotherapy group,65 patients were evaluable for efficacy,and 28(43.1 ％) patients achieved complete remission (CR).The median OS time of patients with CR was significantly longer than that of patients without CR (28.4 months vs 6.0 months,x2=92.048,P=0.000).The 1-year OS rate and 3-year OS rate of 92 elderly patients with AML were 29.3％ (27/92) and 9.8％ (9/92),respectively.②It showed that age,PS score,the white blood cell count,level of serum lactate dehydrogenase,chromosome karyotype and monosomal karyotype (MK) were related to the prognosis of elderly patients with AML (P＜0.05).A multivariate analysis revealed that poor performance (PS score≥ 3 score),white blood cell count≥ 100.0 × 109/L,lactate dehydrogenase elevated ≥ 2 times of the normal value and monosomal karyotype (MK) were independent poor prognostic factors of elderly patients with AML (RR =5.076,11.263,2.297,5.076;P＜0.05).③The early death rate was 22.8％ (21/92) in 92 elderly patients with AML.There was no significant difference in early death rate between chemotherapy group and palliative care group (17.6％ vs 41.7％,x2 =2.314,P=0.128).It showed that age,PS score,the white blood cell count,level of serum creatinine and serum lactate dehydrogenase were related to the early death rate of elderly patients with AML (P＜0.05).Age≥80 years old and the white blood cell count≥100.0 × 109/L were independent risk factors of early death rate with multivariate analysis (OR =0.256,0.158;P＜0.05).Conclusion The aged patients with AML should be stratified according to clinical and biological characteristics and given individualized treatment.
