复发难治性急性髓系白血病临床高危因素分析及再诱导方案疗效评估

目的 分析复发难治性急性髓系白血病（AML）患者的临床和遗传学高危因素,评估再诱导方案疗效.方法 回顾性分析296例初诊AML患者临床资料,观察其中89例复发难治性AML患者的临床特征,对比不同再诱导化疗方案的疗效.结果 与同期收治AML患者相比,初诊时高龄、复杂核型和Fms样酪氨酸激酶3内部串联重复（FLT3-ITD）基因突变是AML复发难治的高危因素（P＜0.05）.复发难治性AML患者再诱导有效率（完全缓解率＋部分缓解率）为44.90％（35/78）.其中使用原方案或无交叉耐药的新药组成联合化疗方案（方案A）再诱导有效率为35.12％（13/37）;含中、大剂量阿糖胞苷（Ara-C）方案（方案B）再诱导有效率为61.90％（13/21）;由阿柔比星或高三尖杉酯碱、小剂量Ara-C联合粒细胞集落刺激因子（G-CSF）组成的预激方案（方案C）再诱导有效率为45.00％（9/20）.方案B再诱导疗效优于方案A,差异具有统计学意义（P＜0.05）.结论 初诊时高龄、复杂核型和FLT3-ITD基因突变是AML复发难治的重要原因.不同的再诱导方案疗效存在差异,对年轻患者选择含中、大剂量Ara-C方案有助于提高再诱导缓解率.对耐受性差的患者,更适合选择预激方案以提高再诱导缓解率.

An analysis of clinical risk factors for relapsed or refractory acute myeloid leukemia and the evaluation of the efficacy of reinduction regimen

Objective To analyze clinical and genetic risk factors of refractory or relapsed acute myeloid leukemia （AML） patients,and evaluate the efficacy of reinduction of chemotherapy.Methods 296 newly diagnosed AML patients,including 89 refractory or relapsed cases,were observed with clinical characteristics.And the efficiency of different reinduction chemotherapy regimens were compared.Results Compared with the non-refractory or relapsed AML,age,complex karyotype and Fms like tyrosine kinase 3 internal tandem duplication （FLT3-ITD） gene mutations were risk factors of relapsed or refractory AML （P 〈 0.05）.Seventy-eight refractory and relapsed AML patients received reinduction therapy.The overall response rate （the complete response rate and the partial response rate） was 44.90 % （30/78）.All reinduction regimens were divided into three categories：using the initial induction scheme or using new induction scheme including some chemotherapeutics without cross-resistance （regimen A）,using the induction regimen containing medium-or high-dose cytarabine （regimen B）,and using priming regimen containing of G-CSF,cytarabine,aclacinomycin or homoharringtonine （regimen C）.Their overall response rate were 35.12 % （13/37）,61.90 % （13/21） and 45.00 % （9/20）,respectively,in which the overall response rate of regimen B was statistically higher than regimen A （P 〈 0.05）.Conclusions Age,complex karyotype and FLT3-ITD mutation were important causes of relapsed or refractory AML.The overall response rates were different among three different reinduction regimens.It is helpful to improve the overall response rate of reinduction therapy to use the regimen containing medium-or high-dose cytarabine,which was more suitable for young patients.For patients with poor tolerance,the priming regimen suit was more helpful to improve the overall response rate.