上海市623例成人急性髓系白血病非选择病例的WHO亚型分布、初治疗效及预后

目的 了解我国急性髓系白血病(AML)治疗的现状以及近20年来AML治疗效果的变化.方法 对2003至2007年中美联合上海市白血病协作组收集的确诊为AML的623例患者,同时采用FAB和WHO分型标准进行分型诊断,并随访患者,统计完全缓解率、生存率和中位生存时间.并与国外的疗效进行同期比较,与20世纪90年代上海地区AML的疗效进行历史对照比较.结果 623例AML患者CR率为66.5%,中位生存时间为18个月,3年生存率为30.8%,3年内的复发率为55.1%,与国外报道的CR率相近,但复发率较高,长期生存率低于国外发达国家.短期和长期治疗效果较之上海市1984至1994年治疗的病例有明显提高.去甲氧柔红霉素、柔红霉素和高三尖杉酯碱诱导治疗的CR率、3年生存率差异无统计学意义.染色体预后良好组去除急性早幼粒细胞白血病(APL)后]的CR率为87.3%(79例中68例),中等组为61.8%(306例中189例),不良组为42.9%(112例中48例),APL的CR率为91.3%,染色体核型是主要的预后因素.经COX模型多因素分析,原发性AML伴多系病态造血的预后与一般原发性AML无明显差异,染色体不良核型、高龄和发病时高白细胞计数是重要的预后因素.结论 上海市AML治疗水平较加年前有明显提高,短期治疗效果已基本达到国际先进水平,但长期疗效尚有待提高.

Distribution of WHO subtypes,initial treatment outcomes and prognosis study of 623 unselected adult patients with acute myeloid leukaemia in Shanghai

Objective To investigate the current status of acute myeloid leukemia (AML) treatment in Shanghai.Methods From 2003 to 2007,a total of successive 623 patients with adult AML were diagnosed and classified according to WHO criteria.Survival rate or median survival was analysed by KaplanMeier curve and COX regression model and to compare the differences in treatment effectiveness with those reported in developed countries and in Shanghai from 1984 to 1994.Results Total CR rate was 66.5%,median survival time was 18 months and estimated survival at 3 year was 30.8%.The 3-year relapse rate was 55.1%.The CR rate was similar to that in developed countries,but long-term survival was worse.The CR rate and survival were increased markedly compared with data collected from 1984 to 1994 in Shanghai.Induction regimens based on idarubicin,daunorubicin or homoharringtonine had similar CR rates and survivals.Karyotype was the most important prognostic factor.The CR rate was 87.3% (68/79),61.8% (189/306)and 42.9% (48/112) in favorable (excluding APL),intermediate and adverse cytogenetic risk groups,respectively.The CR rate of APL was 91.3%.Muhilineage dysplasia in de novo AML was not an independent prognostic factor after adjusted by cytogenetics,age and WBC count.Poor karyotype,old age and high WBC count were the most important prognostic factors.Conclusions The CR rate and survival of AML were improved in the past 20 years.The short-term treatment outcome of AML was comparable to that in developed countries,while the long-term one was worse.Improvement in the long-term treatment outcome in China is an important challenge.