老年急性早幼粒细胞白血病的临床及预后

目的探讨老年急性早幼粒细胞白血病（APL）与年轻APL患者的临床表现、对治疗反应性及长期生存情况，明确老年患者在现有砷剂联合维甲酸及化疗的治疗模式下的有效性和安全性。方法收集北京大学人民医院血液病研究所的247例APL病例，其中老年组21例、年轻组226例，统计临床资料并分析缓解率、复发率、死亡率、存活时间。结果（1）老年APL在性别、白细胞、血红蛋白、血小板、弥散性血管内凝血（DIC）、中枢神经系统白血病（CNSL）及免疫表型上与年轻患者未见明显差异。（2）老年组完全缓解（CR）率、诱导期死亡率稍优于年轻组（100.0%vs 95.1%，0.0%vs 4.4%），但差异均无统计学意义（P＝0.301，P＝0.325）；复发率及CR期死亡率稍高于年轻组（19.0%vs 16.3%，4.8% vs 1.9%），差异亦无统计学意义（P＝0.744，P＝0.095）。（3）4年、6年和7年总存活率及无事件存活率与年轻组比较均无显著差异（P＞0.05）。结论老年APL与年轻APL在临床特点、对治疗的反应性及长期生存上无明显差异，现有治疗模式对老年患者安全、有效。

Clinical and prognostic features of acute promyelocytic leukemia in the elderly

Objective To compare the clinical manifestations, response to treatment and long-term survival of acute promyelocytic leukemia（APL） between elderly and young patients, and to determine the efficacy and safety of the all-trans retinoic acid combining arsenic trioxide and chemotherapy for the elderly. Methods Clinical data of 247 patients with APL admitted in our institute from 1992 to 2010 were collected, and retrospectively studied to compare their clinical manifestations, remission, relapse, mortality and survival rate between elderly （with an age of ≥55, n=21） and non-elderly groups （with an age of 〈55, n=226）. Results （1） There was no significant difference between the elderly and non-elderly APL patients in gender, white blood cells, hemoglobin, platelets, disseminated intravascular coagulation （DIC）, central nervous system leukemia （CNSL）, and immunophenotypes of CD56 and CD117. （2） The rate of complete remission （CR） （100.0%vs 95.1%） and mortality in induction therapy （0.0%vs 4.4%） were a little bit better in the elderly group than the non-elderly group, though without significant difference （P=0.301, P=0.325）. But the relapse rate （19.0%vs 16.3%） and death in CR （4.8%vs 1.9%） were higher in elderly APL than in non-elderly group, and there was no significant difference either between them （P=0.744, P=0.095）. （3） No obvious difference was found in 4-year, 6-year, and 7-year overall survival rate and event-free survival rates between elderly and non-elderly APL （P〉0.05）. Conclusions There is no significant difference between the elderly and non-elderly APL in clinical features, response to treatment and long-term survival. So, the efficacy and safety of current treatment are guaranteed for elderly APL patients.