老年急性白血病340例临床分析

目的分析老年急性白血病的分布及预后情况。方法选取2009年9月至2013年5月在我院未经治疗的、年龄大于60岁的急性白病患者340例，对其发病年龄、预后危险因素、治疗、生存时间等指标进行分析。结果340例60岁以上老年急性白血病患者中，中位发病年龄68岁，急性淋巴细胞白血病（ALL）24例（7.06%）；在急性髓细胞白血病（AML）314例中，初发AML（de novo AML）250例（79.62%）。急性早幼粒细胞白血病（APL）仅9例。初发AML （非APL）中细胞遗传学和分子生物学预后较好的34例（14.11%），预后差的61例（25.31%），随着年龄增加，预后较好的比例降低，而预后差的比例升高。在有生存资料的患者93例中，85例选择了化疗。年龄也对完全缓解（CR）率、总体生存有显著影响。化疗后获得CR的患者生存明显优于未获得CR的患者。结论老年急性白血病患者预后差，如何提高总体生存仍然是一个难题。

Acute leukemia in the elderly: clinical analysis of 340 cases

Objective To investigate the distribution and prognosis of elderly patients with acute leukemia. Methods Clinical data of 340 untreated acute leukemia patients with age over 60 years admitted in our hospital from September 2009 to May 2013 were enrolled in this study. Their onset age, prognostic risk factors, therapy and survival were retrospectively analyzed. Results In this cohort of patients, their median onset age was 68 years. There were 24 patients （7.06%） with acute lymphoblastic leukemia （ALL）. In 314 patients with acute myeloblastic leukemia （AML）, there were 250 patients （79.62%） with de novo AML, and 9 patients with acute promyelocytic leukemia （APL）. There were 34 cases （14.11%） of de novo AML （non APL） having good prognosis based on cytogenetic and molecular biology, and 61 cases having unfavourable prognosis. The proportion of good prognosis was decreased along with the increase of age, while that of unfavourable prognosis was elevated. Among the 93 patients with survival data, 85 of them received chemotherapy. Age also exerted obvious effect on the complete remission （CR） rate and total survival rate. Patients who gained CR after chemotherapy had longer survival than those without CR. Conclusion The prognosis of elderly patients with acute leukemia is poor. How to improve the total survival rate is still a difficult task.