急性髓系白血病-M_4型患者的特征及预后

目的 探讨影响急性髓系白血病(AML)-M_4型患者生存、预后的主要因素.方法 70例AML-M_4患者分为二组:①伴嗜酸粒细胞比例增高但不伴有inv(16)[Eos~+inv(16)~-]组;②嗜酸粒细胞比例增高伴有inv(16)[Eos~+inv(16)~+]组;③不伴有嗜酸粒细胞比例增高(Eos~-)组.总结分析患者临床表现、免疫分型、染色体核型及生存情况,分析影响总体生存(OS)时间、尢复发生存(RFS)时间的因素.结果 70例AML-M_4患者完全缓解(CR)率85.7%,其中1个疗程CR率71.4%;所有患者的中位OS期为20.0(1.2～162.4)个月,达CR患者的中位RFS期为78.0(1.2～129.5)个月;3年、5年OS率分别为42%、42%,3年、5年RFS率分别为59%、54%.Eos组总体CR率76.9%,1个疗程CR率61.5%,中位OS期为11.2个月,中位RFS期为10.8个月;Eos~+组总体CR率96.8%,1个疗程CR率89.6%,中位OS、RFS期未达.统汁学分析表明,两组在总体CR率、OS和RFS期差异均有统计学意义.Eos~+组内分析表明,Eos~+inv(16)~+组总体CR率达100%,1个疗程CR率达94.4%,中位OS、RFS期未达;Eos~+inv(16)~-组总体CR率达91.7%,1个疗程CR率达69.2%,中位OS期为14.3个月,中位RFS期为12.4个月.统汁学分析表明,Eos~+inv(16)~+组、Eos~+inv(16)~-组OS、RFS期差异均有统计学意义.结论单独伴有Eos比例升高可作为AML-M_4患者预后良好因素之一,其中Eos~+inv(16)~+组预后最好.Eos~+组患者具有发病年龄较小、血小板计数低的特点.

Clinical features and prognosis of acute myeloid leukemia-M_4

Objective To investigate factors that affect survival and prognosis of acute myeloid leukemia(AML)-M_4.Methods Seventy AML-M_4 patients were divided into three groups,neither eosinophilia nor inv(16)[Eos~-],eosinophilia with inv(16)[Eos~+inv(16)~+],and eosinophilia with no inv(16)[Eos~+inv(16)~-]. Clinical features,immunophenotype,chromosome karyotype,overall survival(OS) and relapse-free survival(RFS)were analyzed.Results The total complete remssion(CR)rate was 86.9%,CR rate after the first course of induction therapy was 72.4%.The median OS was 20(1.2-162.4)months,and median RFS 78.0(1.2-129.5)months.The 3 and 5 year OS rates were 42%and 42%,and 3 and 5 year RFS rates were 59%and 54%,respectively.The CR rate.CR after the first course of induction therapy and the median OS for the Eos~-group were 78.9%,61.5%and 11.2(1.2-162.4)months;for the Eos~+group were 96.8%,89.6%and did not reach;for the Eos~+invl6~+ group were 100%,94.4%and did not reach;and for the Eos~+inv(16)~- group were 91.7%.69.2% and 14.3 months respectively.The statistical assay showed significant difference between Eos~+inv(16)~- and Eos~+inv(16)~+ groups in OS.The Eos~+ patients present with early onset and low count of platelets.Conclusion Eosinophilia emerged as a favorable prognostic factor,and the concomitant presence of both eosinophilia and inv(16) is associated with a significantly favorlable prognosis.