89例成人融合基因Aml1／Eto阳性急性髓系白血病长期生存分析

本研究探讨影响成人aml1／eto阳性急性髓系白血病患者长期生存的顸后因素。回顾性分析2004年1月至2008年7月本院89例成人aml1／eto阳性急性髓系白血病患者的临床资料，应用Log—Rank检验和Cox回归模型对患者的性别、年龄、初诊时白细胞计数、髓外白血病、中枢神经系统白血病、免疫表型、染色体、诱导缓解方案、诱导缓解疗程数、获得缓解时间、aml1／eto融合基因表达和异基因造血干细胞移植进行了单因素和多因素综合分析。结果表明：89例患者1—42个月随访（中位24个月）的5年预计总体生存率（OS）为（50．0±2．3）％，5年预计无复发生存率（RFS）为（47．0±1．9）％。单因素分析显示，初诊时白细胞计数、髓外白血病、中枢神经系统白血病、表达CD56、诱导缓解疗程数、获得缓解时间、aml1／eto融合基因表达、接受异基因造血干细胞移植均为影响中国成人aml1／eto阳性急性髓系白血病患者长期生存的主要因素。多因素分析显示，初诊时白细胞计数、中枢神经系统白血病、CD56表达、获得缓解所需时间、amll／eto融合基因变化以及接受造血干细胞移植均是影响aml1／eto阳性急性髓系白血病患者长期生存的重要的独立因素。结论：成人aml1／eto阳性急性髓系白血病具有不同于其他人群的特性，其预后相对较差，对于具有不良预后因素的aml1／eto阳性AML成年患者应该建议接受造血干细胞移植。

Long-Term Survival Analysis in 89 Adult Patients with Acute Myeloid leukemia of Fusion Gene Aml1/Eto Positive

This study was aimed to investigate various factors influencing long-term survival in adult AML patients with fusion gene aml1/eto positive. A single institutional retrospective study with long-term follow-up was performed to better define the prognostic factors for AML patients with aml1/eto positive. Newly diagnosed 89 adult AML patients with amll/eto positive were followed up for 1 to 42 months （median 24 months） from January 2004 to July 2008. Univariate and multivariate analysis of potential factors influencing survival and prognosis were carried out by using LogRank and Cox regression method, including sex, age, initial WBC counts, extramedullary leukemic disease, central nervous system leukemia （CNSL）, chromosome aberrations, immunophenotype, first induction regimen, chemotherapy course to complete remission（CR） , time from induction therapy to CR, negative or positive rate of aml1/eto and allogeneic hematopoietic stem cell transplantation and so on. The results showed that the estimated 5-year overal1survival （ OS ） and relapse-free survival （ RFS ） were （ 50.0 ± 2.3 ） % and （47.0 ± 1.9） % respectively in follow-up of 89 patients for 1 -42 months （mean 24 months）. Univariate analysis revealed that initial WBC counts, CNSL, chemotherapy course to CR, time from induction therapy to CR, persistent negative in remission and allogeneic hematopoietic stem cell transplantation were important prognostic factors for long-term survival. Multivariate study demonstrated that initial WBC counts, CNSL, CD56 positive, negative or positive rate of aml1/eto, time from induction therapy to CR, persistent negative result of RT-PCR assay in remission and allogeneic hematopoietic stem cell transplantation were all critical factors in relation to OS and RFS . It is concluded that Chinese adult AML patients with fusion gene ami1/eto positive have some different characteristics as compared with patients from other countries, a relatively poor outcome is observed in patients, HSCT should be recommended to adult AML patients.