不同化疗方案对初诊急性髓系白血病患儿预后及血小板的影响

目的 探讨不同化疗方案对初诊急性髓系白血病(AML)患儿预后及血小板的影响.方法 采用随机数字表法将116例初诊AML患儿分为A组和B组,每组58例.A组患儿采用柔红霉素+阿糖胞苷+依托泊苷(DAE)方案化疗,B组患儿采用柔红霉素+阿糖胞苷(DA)方案化疗.比较两组患儿首次化疗前后的白细胞计数、血小板计数、血小板恢复时间以及首次化疗后异常染色体、骨髓完全缓解、复发情况.采用Logistic回归模型分析首次化疗后AML患儿预后的影响因素.结果 首次化疗后,两组患儿的白细胞计数均明显低于本组化疗前,且A组患儿的白细胞计数明显低于B组,差异均有统计学意义(P﹤0.01).首次化疗后,两组患儿的血小板计数均低于本组化疗前,且B组患儿的血小板计数低于A组,差异均有统计学意义(P﹤0.05).A组患儿的血小板恢复时间明显短于B组,差异有统计学意义(P﹤0.01).首次化疗后,A组患儿异常染色体发生率低于B组,骨髓完全缓解率高于B组,复发率低于B组,差异均有统计学意义(P﹤0.05).Logistic回归分析结果 显示,白细胞计数、DA方案均是AML患儿首次化疗后骨髓完全缓解的危险因素(P﹤0.01),血小板计数是首次化疗后AML患儿骨髓完全缓解的保护因素(P﹤0.01).结论 DAE方案和DA方案均能够改善AML患儿的预后情况,降低血小板水平,但DAE方案的疗效更佳,安全性更高.     

髓系/自然杀伤细胞前体细胞急性白血病一例并文献复习

目的 提高对髓系/自然杀伤细胞前体细胞急性白血病的认识.方法 报道一例髓系/自然杀伤细胞前体细胞急性白血病的临床特点、诊断和治疗经过,并进行文献复习.结果 以DA方案治疗2个疗程后达完全缓解,此后以大剂量阿糖胞苷巩固化疗,目前患者处于持续完全缓解状态.结论 髓系/自然杀伤细胞前体细胞急性白血病对急性髓系白血病化疗方案的反应优于对急性淋巴细胞白血病化疗方案的反应,参照急性髓系白血病的化疗方案大部分可以达到完全缓解,但总体来说缓解期短,缓解后易复发,患者的中位生存期仅为19个月.     

小剂量及标准剂量化疗治疗老年人急性髓系白血病的疗效研究

 目的　评价小剂量、超小剂量化疗及标准剂量化疗治疗老年人急性髓系白血病（AML）的疗效,寻找小剂量化疗的适应证。方法　回顾性分析1993年1月至2008年11月收治的77例≥60岁AML患者的病例资料,分析小剂量、超小剂量和标准剂量化疗的近期和远期疗效。结果　总样本中小剂量、超小剂量组患者的年龄较大、PS评分较高、白细胞较低,但与标准剂量组比,完全缓解（CR）率、总有效率（ORR）、无事件生存率（EFS）和总生存率（OS）差异均无统计学意义。按照年龄或PS评分细分亚组,小剂量、超小剂量组在＜70岁和PS评分≤2的亚组中,不论近期、远期疗效都明显优于标准剂量组;而在＞70岁和PS评分＞2的亚组中,两组疗效差异无统计学意义。进一步分析显示：小剂量化疗并未降低化疗相关死亡,也未增加远期复发的风险。结论　小剂量、超小剂量化疗与标准剂量化疗相比可以改善老年人AML患者的预后,而且更适用于年龄较轻、一般情况较好的部分老年患者。     

134例老年急性髓系白血病的临床特点及预后分析

目的：分析老年急性髓系白血病（acute myeloid leukemia,AML）（非早幼粒细胞白血病）的临床特点,治疗方式以及疗效和预后特点。方法：收集2015年1月至2023年2月北京大学国际医院收治的134例老年AML患者资料,回顾性分析患者初诊时的白细胞计数、骨髓原始细胞计数、细胞遗传学及分子学特点、ELN危险分层,根据不同治疗方案将患者分为高强度化疗组和低剂量治疗组,观察在治疗过程中强化疗是否能给患者带来生存获益以及影响老年患者生存的因素。结果：高强度化疗患者36例,22例完全缓解（complete response,CR）(61.1%),低剂量治疗90例中46例获得CR(51.1%),其中19例阿扎胞苷（AZA）联合维奈克拉（VEN）治疗换着中14例获得CR(73.7%);高强度化疗与低剂量治疗的总生存期（overall survival,OS）分别为15个月和14.5个月（P=0.226）。欧洲白血病网（ELN）危险分层低、中、高危组患者OS分别为18、14、9个月（P=0.009）,低危组高强度化疗和低剂量治疗的OS分别为22个月和15个月（P=0.745）,中危组分...     

原发性中枢神经系统淋巴瘤患者预后的影响因素分析

目的探讨原发性中枢神经系统淋巴瘤(PCNSL)患者预后的影响因素。方法收集82例PCNSL患者的临床资料,包括性别、年龄、病灶数量、病灶部位、病灶直径、治疗方法、意识状态、体力状况(PS)评分等一般资料,以及脑脊液(CSF)常规检测指标(CSF蛋白质、CSF氯化物)和生化检测指标[血清乳酸脱氢酶(LDH)、β2微球蛋白(β2-MG)]等实验室检查资料。对所有患者进行2年随访,采用多因素Cox回归模型分析PCNSL患者预后的影响因素。结果单因素分析结果显示,年龄﹤60岁、意识正常、PS评分﹤1分的PCNSL患者的2年生存率分别高于年龄≥60岁、意识障碍、PS评分≥1分的患者,差异均有统计学意义(P﹤0.05)。Cox多因素分析结果显示,年龄≥60岁、意识障碍均是PCNSL患者预后的独立危险因素(P﹤0.05)。结论年龄和意识状态均是PCNSL患者预后的独立影响因素,年龄越大、意识状态越差,患者的预后越差。     

CD7阳性的急性髓系白血病临床及细胞遗传学特征

 目的 研究CD7在急性髓系白血病（AML）患者中的表达情况,分析CD7阳性AML患者临床特点与细胞遗传学特征。方法 对130例AML患者进行研究,用流式细胞仪检测免疫表型,比较CD7阳性AML和CD7阴性AML患者的性别、年龄、外周血白细胞计数、骨髓原始细胞计数等。同时检测CD7阳性患者的染色体核型。结果 AML患者的CD7阳性率为10 %,CD7阳性AML外周血白细胞计数、骨髓原始细胞计数、染色体异常率均高于CD7阴性者。完全缓解率低,生存期短。CD7阳性AML染色体异常率为71.4 %,预后差核型多见。结论 CD7抗原可作为疾病预后差、复发、恶化的指标,CD7阳性的AML患者预后不良。     

微移植联合化疗治疗老年急性髓系白血病临床观察

目的:观察微移植联合化疗治疗老年急性髓系白血病患者的临床疗效及安全性.方法:回顾性分析我院35例老年急性髓系白血病患者经单纯诱导化疗(n=16)或联合微移植(n=19)的治疗过程及转归情况.结果:微移植联合化疗组14例(73.7%)完全缓解(CR),单纯诱导化疗组6例(37.5%)CR;微移植组中性粒细胞、血小板中位恢复时间分别为11.5 d、16 d,而单纯诱导化疗组则分别为15 d、22 d(P<0.05);微移植组无重症感染及相关死亡发生,单纯化疗组因重症感染死亡3例.结论:微移植联合化疗治疗老年急性髓系白血病提高了疾病缓解率,降低了化疗相关死亡率.     

急性髓系白血病预后相关因素分析

目的 探讨成年急性髓系白血病(AML)患者的预后影响因素.方法 回顾性分析182例初治AML患者临床资料,探讨患者性别、年龄(以60岁为界)、初治白细胞计数(≥30× 109/L)、骨髓细胞学免疫表型、细胞遗传学、异基因造血干细胞移植(allo-HSCT)和治疗1个疗程获得完全缓解(CR)等因素与总生存(OS)及无事件生存(EFS)的关系.结果 182例AML患者的中位年龄49岁(14～ 80岁),中位随访时间9.7个月(0.5～75.5个月),首次化疗达CR 107例,总有效率为65.9％(120/182),年龄≥60岁、CD64阴性、染色体高危组及首次诱导未达CR患者的总CR率低于无上述因素者.单因素生存分析提示年龄≥60岁、细胞遗传学高危组、CD19阴性、CD11b阳性、CD64阴性、未行allo-HSCT、首次诱导未达到CR的患者OS及EFS较短(P＜0.05),多因素分析显示年龄、细胞遗传学表达、CD11b、CD64、是否行allo-HSCT、首次诱导能否达CR是患者OS的独立预后因素,细胞遗传学表达、CD64表达、是否行allo-HSCT及首次诱导能否达CR是患者EFS的独立预后因素.结论 根据AML相关因素进行预后分析判断,有利于临床医生早期制订个体化治疗方案,对于延长患者生存期有重要意义.     

77例老年急性髓性白血病患者的预后因素分析

背景与目的:老年急性髓性白血病(acutemyelogenousleukemia,AML)有独特的生物学及临床特征,患者对治疗的反应差、生存期短。本研究旨在探讨老年AML的预后因素。方法:对上海市第一人民医院1994～2005年收治的77例老年AML患者可能影响预后的因素进行Kaplan-Meier生存分析,然后对有意义的因素进行Cox比例风险模型分析。结果:可评价患者72例。年龄60～70岁者中位生存期(350天)显著长于年龄>70岁者(60天)(P<0.001),CR率显著提高(71.4%vs.29.4%,P=0.001);生存状态(performancestatus,PS)0或1分者中位生存期(402天)显著长于2、3、4分者(31天)(P<0.001),CR率显著提高(75.0%vs.15.0%,P<0.001);原发者中位生存期(98天)显著长于继发者(32天)(P=0.007),CR率显著提高(50.0%vs.0%,P=0.023);使用亚标准剂量的蒽环类药物者中位生存期(293天)显著长于减量使用者(35天)(P=0.006),CR率显著提高(63.6%vs.33.3%,P=0.02)。骨髓原始细胞(bonemarrowblastcell,BMblast)比率≤50%者中位生存期(98天)显著长于>50%者(55天)(P=0.006);预后良好核型者中位生存期(293天)显著长于预后不良或正常核型者(31天)(P=0.005);CD34阴性者中位生存期(201天)显著长于阳性者(36天)(P<0.001)。外周血白细胞数量(peripheralbloodwhitebloodcellcount,PBWBC)大于10×109/L者CR率(50.0%)显著高于PBWBC小于10×109/L者(25.0%)(P=0.043);化疗者CR率(50.0%)显著高于支持治疗者(0%)(P=0.001)。Cox比例风险模型分析显示影响生存期的7个因素均具有独立性和统计学意义。结论:年龄>70岁、PS为2～4分、骨髓原始细胞比率>50%、继发性、不良核型、CD34 以及蒽环类药物剂量强度是影响患者生存期的主要预后因素,蒽环类药物剂量显著影响CR率。     

成人急性髓系白血病表面标记分析的预后价值

成人急性髓系白血病表面标记分析的预后价值朱薇波，吴树农，舒兆龙，蔡晓燕，张明水，刘欣急性髓系白血病（ＡＭＬ）是成人最常见的急性白血病。虽然化疗后完全缓解（ＣＲ）率明显提高，但多数病人仍死于复发。探讨有预后价值的亚型实属必要。以往研究认为：年龄大于６０...     

老年正常核型急性髓系白血病患者临床特征及预后分析

目的 探讨老年正常核型急性髓系白血病(CN-AML)患者的临床特征及其预后相关因素.方法 回顾性分析104例初治老年CN-AML(M3除外)患者的临床资料.用χ2检验分析完全缓解(CR)的影响因素.用Kaplan-Meier法进行生存分析,并采用Log-rank检验对预后相关影响因素进行单因素分析,采用Cox回归模型进行多因素分析.结果 104例患者中首次化疗后可评价疗效者72例,CR率为38.9%(28/72),总有效率为55.6%(40/72).白细胞计数(WBC)<100×109/L、NPM1突变阳性患者的CR率较高[59.4%(38/64)比12.5%(1/8),83.3%(10/12)比36.4%(8/22),均P<0.05].104例患者中位总生存(OS)时间为6.9个月.单因素分析显示年龄≥70岁、继发AML、高WBC(≥100×109/L)、FLT3-内部串联重复(ITD)突变阳性、CD7阳性、达CR诱导疗程数>2个以及Charlson合并疾病指数(CCI)评分≥2分的患者OS时间较短(均P<0.05).多因素分析显示FLT3-ITD突变阳性(HR=7.61,95%CI 1.80~32.11,P=0.006)及达CR诱导疗程数>2个(HR=10.11,95%CI 2.38~43.03,P=0.002)是患者OS的独立不良影响因素.结论 老年CN-AML患者的预后是多种因素综合作用的结果,FLT3-ITD突变阳性、 达CR诱导疗程数>2个是老年CN-AML患者不良OS的独立影响因素.     

Prognostic factors and treatment effects on survival in acute myeloid leukemia of M6 subtype: A retrospective study of 54 cases

Background:Since 1976, erythroleukemia has been included within the FAB classification system of acute myeloid leukemia (AML) which designates it as M6 AML. This report describes the data of 54 patients with newly diagnosed M6 AML, consecutively seen in our hospital between May 1976 and May 1999. Patients and methods:There were 40 males and 14 females. Median age was 59 years. Pancytopenia was the most common feature at diagnosis. Twenty-six percent of cases presented with secondary AML. Karyotype was successfully performed in 35 cases. Eleven patients presented with normal karyotype, nine with simple karyotypic abnormalities, and fifteen with major karyotypic abnormalities. Fifty of the fifty-four patients received one or two courses of induction chemotherapy combining anthracyclines with cytarabine according to different successive protocols. One elderly patient only received low-dose cytarabine, and three patients died before any chemotherapy could be given. Results:Complete remission (CR) was achieved in 29 cases (54%, 95% confidence interval (CI): 40%–67%). As post-remission therapy, four patients could be allografted, and two underwent autologous transplantation. All other treated patients received continuation chemotherapy. Twenty-one patients have relapsed (72%). Median time to relapse was six months. Among those patients, only eight achieved a second CR (38%). The median disease-free survival (DFS) was eight months (95% CI: 4–10 months) with a five-year survival rate of 17%. Median overall survival (OS) was nine months (95% CI: 5–12 months) with a five-year survival rate of 13%. In univariate analysis, poor prognostic factors for DFS were secondary AML (P = 0.05) and initial platelet count <50 × 109/l (P = 0.02). Poor prognostic factors for OS were age 60 years (P = 0.005), secondary AML (P = 0.05), initial blastic fever (P = 0.0004), and initial haemoglobin level <90 g/l (P = 0.03). All factors, but haemoglobin level, remained significant in the multivariate analysis. Although it was not statistically significant, there was a trent for a better prognosis of M6 patients presenting with normal karyotype as compared to those displaying chromosomal abnormality. Conclusions:This retrospective analysis points to a somewhat heterogenous group of AML in terms of clinical and biological features, and outcome. Distinctive subgroups can be identified according to prognostic factors related to survival. A larger multicenter study with well-defined diagnostic criteria is warranted to further clarify treatment effects.     

319例晚期肺腺癌患者临床预后因素分析

目的：分析影响晚期肺腺癌患者的临床预后因素。方法回顾性研究319例Ⅲb ~Ⅳ期肺腺癌患者的临床资料,应用 Kaplan-Meier 方法计算生存率,采用 Cox 多因素回归对预后因素进行分析。结果319例患者的中位生存期为13.0个月,1、2、3 a 生存率分别为53.0%、26.1%、18.1%。单因素分析显示 PS 评分,治疗前外周血红蛋白、白蛋白及中性粒细胞,TNM 分期,首诊伴骨、肝、脑转移及转移器官数目,一线化疗周期数,是否应用 EGFR-TKI 与晚期肺腺癌患者生存有关（P ﹤0.05）。多因素分析显示 PS 评分,治疗前外周血红蛋白、白蛋白、中性粒细胞,TNM 分期,首诊伴脑转移,转移器官数目,一线化疗周期数及 EGFR-TKI的应用与晚期肺腺癌患者生存有关（P ﹤0.05）。在对接受 EFGR-TKI 治疗的83例患者的亚组分析中发现,既应用 EFGR-TKI 又接受化疗者的中位生存期最长,但各亚组间生存期差异无统计学意义（ P ﹥0.05）。结论 PS 评分,治疗前外周血红蛋白、白蛋白、中性粒细胞,TNM 分期,首诊伴脑转移,转移器官数目,一线化疗周期数及 EFGR-TKI 的应用是影响晚期肺腺癌患者预后的独立危险因素。EFGR-TKI 的应用可以为晚期肺腺癌患者带来生存获益,既应用 EFGR-TKI 又化疗的患者可能为获益最大。     

De novo acute myeloid leukemia in the elderly; a consistent fraction of long-term survivors by standard-dose chemotherapy

To clarify the characteristics of de novo acute myeloid leukemia (AML) among the elderly, we reviewed 112 patients over 60 years old (median age 72 years) who were treated at hospitals in Nagasaki Prefecture with a population of 1.5 million between 1987 and 1994. Reclassification of morphological diagnosis revealed that the proportion of M3 was lower but that of M6 and the incidence of cases with trilineage dysplasia (TLD), known as poor prognostic features, were higher in the elderly than in patients less than 60 years old. Similarly, chromosomal data showed a lower frequency of favorable karyotypes such as t(8;21) and t(15;17) in the elderly. The overall survival of all 112 patients was 10.3% at 5 years. Multivariate analysis indicated that good performance status (PS), low WBC at diagnosis, standard dose multi-drug chemotherapy and all-trans retinoic acid (ATRA) treatment for M3 patients, and morphological findings without TLD were significantly correlated with longer survival. Most of the long-term survivors were found among those who received standard dose therapy in this series, although no consensus has been established how to treat elderly AML patients. We propose that a prospective controlled trial is necessary to confirm the role of standard dose chemotherapy for elderly patients with de novo AML.     

A prognostic model for advanced stage nonsmall cell lung cancer. Pooled analysis of North Central Cancer Treatment Group trials

BACKGROUND: A pooled analysis was performed to examine the impact of pretreatment factors on overall survival (OS) and time to progression (TTP) in patients with advanced-stage nonsmall cell lung cancer (NSCLC) and to construct a prediction equation for OS using pretreatment factors. METHODS: A pooled data set of 1053 patients from 9 North Central Cancer Treatment Group trials was used. Age, gender, Eastern Cooperative Oncology Group performance status (PS), tumor stage (Stage IIIB vs. Stage IV), body mass index (BMI), creatinine level, hemoglobin (Hgb) level, white blood cell (WBC) count, and platelet count were evaluated for their prognostic significance in both univariate and multivariate analyses by using a Cox proportional-hazards model. RESULTS: Patients who had high WBC counts, low Hgb levels, PS >0, BMI < 18.5 kg/m2, and TNM Stage IV disease had significantly worse TTP and OS. Patients who had Stage IV disease with a high WBC count had a particularly poor prognosis. An equation to predict the OS of patients with Stage IV NSCLC based on pretreatment PS, BMI, Hgb level, and WBC count was constructed. CONCLUSIONS: In addition to the widely accepted prognostic factors of PS, BMI, and disease stage, both of the readily available laboratory parameters of Hgb level and WBC count were found to be significant prognostic factors for OS and TTP in patients with advanced-stage NSCLC. The authors' prediction equation can be used to evaluate the benefit of a treatment in Phase II trials by comparing the observed survival of a cohort with its expected survival by using the patients' own prognostic factors in place of comparisons with historic data that may have substantially different baseline patient characteristics.     

Analysis of Prognostic Factors in 108 Patients with Non-Hodgkin's Lymphoma

OBJECTIVE To analyze the prognostic factors in patients with non-Hodgkin's lymphoma (NHL) and to investigate the prognostic value of the absolute lymphocyte count (ALC) in peripheral blood in NHL patients at admission.METHODS The clinical features and follow-up data from 108 NHL patients whose diagnosis was confirmed through pathologic examination during a period from January 2000 to January 2008 were reviewed. SPSS 14.0 package was used for statistical analysis,and the Kaplan-Meier curve method for assessment of survival probability. Furthermore, the Cox regression model was utilized for multivariate analysis for all parameters which were statistically significant and confirmed by univariate analysis.RESULTS In the 108 NHL patients, the male-female ratio was approximately 1.5: 1 and the median age was 48 years. Before treatment, 61.1% of the patients had stage Ⅰ and Ⅱ disease, based on the Ann Arbor Clinical Classification. The ECOG performance status (PS) score reached a range from 0 to 1 in about 93% of total patients, and an elevated serum lactate dehydrogenase (LDH) was seen in 19.2%. Based on the international prognostic index (IPI) score, 80.6% of patients were in the low risk group. On admission,35.2% of patients had an ALC ≤1×109/L. Anemia, i.e. hemoglobin (Hb)≤110 g/L was seen in 29.6% and B-symptoms in 26.9% of patients. The mean value of Hb was 129.2±17.5 g/L in patients with ALC >1×109/L (n=70) and 98.1±20.6 g/L in those with ALC≤1×109/L (n=38), and the difference between the 2 groups was statistically significant (P<0.05). With a median follow-up period of 2 years, the median survival time was 2.3 years among all patients. The 2-year and 5-year overall survival (OS) rates were 73.2% and 39.6%, respectively. It was shown by univariate analysis that ALC ≤1×109/L, Hb≤110 g/L, B-symptoms, and the IPI≥2 were statistically significant unfavorable prognostic factors in NHL patients. Multivariate analysis revealed that ALC≤1×109/L, B-symptoms, and the IPI≥2 were independent unfavorable prognostic factors in NHL patients.CONCLUSION The numerical value of ALC and the presence of B-symptoms are prognostic factors independent of IPI in NHL patients. Clinically, determining prognosis based on the IPI combined with simple clinical parameters, such as the numerical value of ALC and B-symptom status, might be of more practical value in determining individualized treatment regimens for NHL patients.     

Impact of socioeconomic status and distance from treatment center on survival in patients receiving remission induction therapy for newly diagnosed acute myeloid leukemia

BACKGROUND: While socioeconomic status (SES) and the distance patients travel to a treatment center (DTC) impact survival of certain solid tumors, little is known of their influence in acute myeloid leukemia (AML). METHODS: We retrospectively reviewed patients receiving remission induction therapy for AML at the Cleveland Clinic between January 1997 and December 2005. Demographic data were obtained from medical records. Income and DTC were determined using online databases. Known prognostic factors (age, WBC count at diagnosis, cytogenetics, AML etiology) were collected and controlled for in Cox proportional hazards analysis. RESULTS: Induction chemotherapy was administered to 281 patients; 91% were Caucasian (C), 8% were African American (AA), and 1% were neither (non-AA non-C). The median DTC was 24 miles (range, 0.9-2058), and median annual household income was USD 38,972 (range, USD17,496-143,220). With a median follow up of 22.6 months, the median overall survival (OS) was 11.3 months. In multivariable analyses, age >or=60 years, unfavorable cytogenetics, initial WBC count and secondary AML significantly influenced survival (p<0.001, p<0.001, p=0.035, and p=0.010, respectively). OS was similar for AAs and non-AA non-Cs compared to Cs (HR=1.12, 95% CI=.61-2.07, p=.71, and HR=0.87, CI=0.21-3.62, p=.84, respectively). Neither DTC (HR=1.00, 95%CI=0.98-1.01, p=.96 per 20 mile increment) nor SES (HR=1.02, 95%CI=0.92-1.13, p=.77 per USD10,000 annual income increase) had an impact on OS. CONCLUSION: Unlike with many solid tumors, SES and DTC are not predictive of outcome in AML patients.