治疗相关性急性髓细胞白血病患儿的临床分析

目的探讨治疗相关性急性髓细胞白血病(tAML)患儿的治疗毒性和治疗结果,并与原发性急性髓细胞白血病(pAML)相比较。方法回顾性分析了1990年至2005年收治的21例tAML患儿的治疗毒性反应、治疗结果资料;从同一数据库中的255名pAML患儿中,按随机数字表法选择同一时段被诊断为pAML的42名患儿作为对照组。应用SPSS 11.0软件进行统计学处理。使用卡方检验将研究组和对照组的治疗毒性进行比较;使用卡方检验将研究组和对照组的混合系白血病基因(MLL)、第5或7号染色体异常发生率进行比较:使用Fisher’s精确概率法检验异基因造血干细胞移植(HSCT)对病例组生存率的影响;使用Kaplan-Meier方法进行总生存率(OS)分析,用log-rank检验组间生存率。结果tAML的治疗毒性和pAML相比无显著性差异;病例组MLL异常、5号7号染色体异常发生率均高于对照组,具有显著性差异;tAML的OS和pAML相比更低,具有显著性差异(P=0.035);21名tAML的3年总生存率(OS)为19.0%,所有的存活者均在第一次缓解时接受过异基因造血干细胞移植(HSCT)。结论和pAML患儿相比,tAML患儿治疗效果更差,这可能归因于细胞遗传学改变,而不是因为tAML患儿具有更大的治疗毒性。在第一次缓解时行HSCT对于改善tAML患儿的预后非常重要。

Clinical analysis of treatment related acute myeloid leukemia in children

Objective To explore the drug toxicity and treatment outcome of treatment related acute myeloid leukemia(tAML) in children and compare them to children with primary AML(pAML).Methods We retrospectively reviewed the drug toxicity,and outcome data of 21 children with tAML treated at our institution between 1990 and 2005.A control group,consisting of 36 patients who were diagnosed in the same time period with primary AML(pAML) was identified by means of random number table from the same database in which 255 pAML patients were recorded. Software of SPSS 17.0 was used to analyze all data.The drug toxicities were compared between the cases and controls using a Chi-squared test.The frequency of mixed lineage leukemia gene(MLL) rearrangements and abnormalities in chromosomes 5 or 7 were compared between the two groups using a Chi-squared test.Fisher's exact test of probabilities was applied to assess the influences of HSCT to overall survival(OS).OS was calculated using the Kaplan-Meier method,and differences in survival were compared between the cases and controls using the log-rank test.Results Compared to pAML patients,tAML had a inferior OS(P=0.035) but no significant difference in treatment toxicity.Three years OS of 21 patients with tAML was 19.0%.All survivors were treated with allogeneic hematopoietic stem cell transplantation(HSCT).Conclusion In sunmmary,our study demonstrated poorer outcome in patients with tAML compared to those with pAML.These differences were likely due to a higher probability of poor cytogenetic features in the tAML group rather than excessive toxicities.It was important for children with tAML to be treated with HSCT in first remission in order to improve prognosis.