伴有复杂核型的急性白血病患者的临床特征及其对预后的影响

目的：探讨复杂核型急性白血病（AL）患者的临床特征，初步阐明其与预后的关系。方法：选择33例复杂核型AL患者为研究对象（复杂核型组），从同时间诊断的248例非复杂核型AL患者中随机抽取43例患者作为对照（非复杂核型组）。收集2组患者的临床和实验室资料，分析临床特征及其与预后的关系。结果：与同期非复杂核型组比较，复杂核型组患者性别、年龄、治疗前的血液学指标、骨髓原始细胞比例及髓外浸润等差异均无统计学意义（P>0.05）；复杂核型AL在AL患者中的构成比为11.7%（33/281）。复杂核型组和非复杂核型组患者的完全缓解（CR）率分别为59.4%（19/32）和85.0%（34/40），二者比较差异有统计学意义（P=0.014）；复杂核型和非复杂核型急性髓系白血病（AML）患者CR率分别为47.6%（10/21）和79.3%（23/29），二者比较差异有统计学意义（P=0.020）；核型复杂程度高和核型复杂程度低的复杂核型AL患者CR率分别为41.2%（7/17）和80.0%（12/15），二者比较差异有统计学意义（P=0.036）。Kaplan-Meier生存分析，复杂核型组和非复杂核型组AL患者中位无复发生存时间（RFS）和中位总生存时间（OS）分别为162和462d（P=0.002）及256和769d（P<0.01），二者比较差异有统计学意义。AML和急性淋巴细胞白血病（ALL）患者中，复杂核型组和非复杂核型组患者中位OS分别为125和741d（P<0.01）及293和939d（P=0.008），二者比较差异有统计学意义。结论：复杂核型AL在AL患者中的构成比较低，一般临床特征无明显差异，但疗效及预后较差；复杂核型AL患者染色体复杂程度越高，疗效越差。

Clinical characteristics of acute leukemia patients with complex karyotypes and their effects on prognosis

Objective: To investigate the clinical characteristics of the acute leukemia (AL) patients with complex karyotypes, and to elucidate their relationships with prognosis. Methods: A total of 33 AL patients with complex karyotypes were selected as the subjects (complex karyotype group), and 43 cases were randomly selected from 248 non-complex karyotype AL patients diagnosed at same time as the controls(non-complex karyotype group). The clinical and laboratory data of the patients in two groups were collected and the clinical characteristics and their relationships with prognosis were analyzed. Results: There were no significant differences in gender, age, hematological indexes before treatment, proportion of bone marrow primordial cells and extramedullary infiltration between the AL patients with complex karyotypes and non-complex karyotypes at same time (P>0.05); the constituent ratio of complex karyotypes AL in the AL patients was 11.7% (33/281).The complete remission (CR) rates of the AL patients in complex karyotype group and non-complex karyotype group were 59.4% (19/32) and 85.0% (34/40),there was significant difference between two groups (P=0.014); the CR rates of the acute myeloid leukemia (AML)patients in complex karyotype group and non-complex karyotype group were 47.6% (10/21) and 79.3% (23/29), there was significant difference between two groups (P=0.020).The CR rates of complex karyotypes AL patients with high karyotype complexity and low karyotype complexity were 41.2% (7/17) and 80.0% (12/15), there was significant difference between two groups(P=0.036).The Kaplan-Meier survival analysis showed that the median recurrence-free survival (RFS) and median overall survival (OS) of the patients in complex karyotype group and non-complex karyotype group were 162 and 462 d(P=0.002),256 and 769 d(P<0.01), and there were significant differences between two groups;the median OS of the AML and acute lymphoblastic leukemia(ALL) patients in complex karyotype group and non-complex karyotype group were 125 and 741 d (P<0.01), 293 and 939 d (P=0.008), and there were significant differences between two groups. Conclusion: The constituent ratio of complex karyotypes in the AL patients is relatively lower, and there are no significant differences in the general clinical characteristics, but the curative effect and prognosis are poor. The higher the chromosome complexity degree of the AL patients with complex karyotypes, the worse the curative effect.