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.

Analysis on prognostic factors of acute myeloid leukemia

Objective To investigate the correlated factors of prognosis for acute myeloid leukemia (AML).Methods A retrospective analysis of initial 182 patients with AML was performed to assess the relationship between prognostic factors including sex,age,white cell count at diagnosis,immunophenotype,cytogenetics,allo-HSCT and complete remission (CR) after one-course of induction and overall survival (OS) or event free survival (EFS).Results The median age of 182 patients was 49 (14-80) years old,and the median follow up was 9.7 (0.5-75.5) months.There were 107 patients achieved CR after one-course of induction (total response rate was 65.9 ％,120/182),age≥60 years.CD64 negative,unfavorable cyto-genetics and failing to achieve CR after one-course of induction were associated with lower total CR rate.Univariate analysis results demonstrated that age ≥60 years,unfavorable cytogenetics,CD11b expression and failing to achieve CR after one-course of induction had poor influence on 3-years OS and EFS,while the 3-years OS and EFS for patients with CD19 expression,CD64 expression and allo-HSCT were better than that of the patients with negative CD19 and CD64.Multivariate analysis suggested that age,cytogenetics,CD11b,CD64,allo-HSCT and CR after one-course of induction were independent prognostic factors for OS,while cytogenetics,CD64,allo-HSCT and CR after one-course of induction were important on EFS.Conclusions Prognostic analysis depending on AML corelation factors is benifit to individual therapy and can be applied to improve the survival.