摘要
目的探讨HCT—CI评分系统预测老年急性髓系白血病（AML）患者化疗风险及在预后判断中的价值。方法回顾性分析2000年1月至2010年12月收治的116例年龄〉160岁AML患者的临床资料，116例患者均接受以阿糖胞苷为基础的诱导缓解化疗方案，包括DA、MA、IA、AA、CAG方案，后继以中大剂量阿糖胞苷或阿糖胞苷联合蒽环类的诱导缓解后化疗。①针对患者合并症情况进行HCT—CI评分，并比较不同分值患者接受化疗后的早期死亡率、中位生存时间。②对患者多种预后危险因素进行分析。评价HCT—CI评分是否可作为老年AML患者预后的独立危险因素。结果①116例患者均获得随访，按HCT—CI评分分为0分组、1—2分组及≥3分组。3组的早期死亡率分别为3．7％、12．1％、23．2％，差异具有统计学意义（P〈0．01）。中位生存时间分别为345、225、113d，差异有统计学意义（P〈0．01）。②单因素及COX比例风险模型多因素分析显示HCT—CI评分≥3分（P〈0．01）、骨髓增生异常综合征（MDS）病史（P=0．035）、高危染色体核型（P=0．018）发病时WBC≥100×109／L（P=0．031）均是影响老年AML预后的独立危险因素。结论①HCT—CI评分系统可对老年AML患者合并症进行量化评估，可客观地预测老年AML患者的化疗风险。②MDS病史、高白细胞、高危染色体核型、HCT-CI评分1≥3分是老年AML患者的独立不良预后因素。
Objective To investigate the value of the HCT-CI score in chemotherapy risk assessment and prognosis of elderly patients with acute myeloid leukemia （AML）. Methods The clinical data of 116 AML patients older than 60 years in the department of Hematology, Henan Provincial People＇ s Hospital from January 2000 to December 2010 were analyzed retrospectively. All patients received cytarabine-based regi- mens, including protocol DA, MA, IA, AA or CAG, followed by cytarabiue-based postremission treatment. ①Comorbidities were evaluated by using HCT-CI score, the early death rates and median survival time were compared among these different groups. ②These prognostic factors were analyzed by univariate and multivari- ate analyses. Results ①All 116 eases were followed-up. The patient cohort was divided into those with HCT-CI scores of 0, 1 or 2, or ≥3. Early death rates were 3.7% , 12.1% and 23.21% in above three groups, respectively （P 〈 0.01 ）. Overall survival were 345, 225 and 113 days, respectively （P 〈 O. 01 ）. ②HCT-CI score ≥ 3 （ P 〈 0.01 ）, antecedent MDS history （ P = 0. 035 ）, high-risk karyotype （ P = 0.018 ）, white blood cells at diagnosis ≥ 100 ~ 109/L （P = 0. 041 ） were independent adverse prognostic factors with multivariate analysis. Conclusion ①The HCT-CI score can objectively assess elderly AML patients with co- morbidities and predict chemotherapy risk in older patients receiving AML induction therapy. ②Antecedent MDS history, high-risk karyotype, high white blood cell, and HCT-CI score ≥3 are independent adverse prognostic factors of elderly AML patients.
出处
《中华血液学杂志》
CAS
CSCD
北大核心
2013年第1期8-11,共4页
Chinese Journal of Hematology
