摘要
目的探讨急性髓系白血病M2型(AML-M2)的临床特点及预后影响因素。方法收集本院2013年1月-2017年12月住院治疗128例AML-M2患者临床资料,分析其临床特征并用COX回归进行预后因素的单因素和多因素分析。结果128例患者中位年龄43(13-70)岁,男性63例,女性65。90%以上表达CDl3、CD33、CD34、CD117等表面抗原,CD19+(14.4%),CD56+(8.8%)。核型正常患者71例,t(8;21)患者52例,其中单纯t(8;21)患者25例,伴附加染色体异常27例,主要为性染色体的缺失(-X/-Y)。分子学检测提示,FLT3-ITD、c-Kit、NPM1、CEBPA基因突变分别占11.6%、10.4%、15.1%、20.9%。首次诱导治疗缓解率(CR),IA方案优于DA方案,差异有统计学意义(P<0.05)。单因素分析示:女性、不伴附加染色体异常、中大剂量阿糖胞苷≥3次、行HSCT的患者在OS、PFS上均有优势(P<0.05)。多因素分析示:中大剂量阿糖胞苷疗程数≥3次的患者在OS、PFS上明显优于中大剂量阿糖胞苷<3次的患者(P<0.05)。结论本中心患者的总体CR率为92.2%,IA组的总体完全缓解率优于DA组(P=0.036)。中大剂量阿糖胞苷疗程数≥3次是预后良好因素,伴附加染色体异常的预后不良因素,造血干细胞移植可使患者获得更好的长期疗效。
Objective To investigate the clinical features and prognostic factors of acute myeloid leukemia M2(AML-M2). Methods The clinical data of 128 patients with AML-M2 admitted to our hospital from January 2013 to December 2017 were collected. The clinical features were analyzed and COX regression was used to analyze the prognostic factors by single factor and multivariate analysis. Results he median age of the patients was 43(13-70) years old,63 males and 65.90% females expressed surface antigens such as CDl3,CD33,CD34 and CD117,CD19+(14.4%) and CD56+(8.8%). There were 71 patients with normal karyotype and 52 patients with t(8;21),including 25 patients with t(8;21) alone and 27 with additional chromosomal abnormalities,mainly sex chromosome deletion(-X/-Y). Molecular examination showed that the FLT3-ITD,c-Kit,NPM1,and CEBPA gene mutations accounted for 11.6%,10.4%,15.1%,and 20.9%,respectively. The first induction of treatment response rate (CR),IA regimen was superior to DA regimen,the difference was statistically significant(P<0.05). Univariate analysis showed that women,patients with no additional chromosomal abnormalities,medium and large doses of cytarabine ≥3 times,and HSCT patients had advantages in OS and PFS (P<0.05). Multivariate analysis showed that patients with moderate to high doses of cytarabine ≥3 times were significantly better than those with moderate to high doses of cytarabine <3 times in OS and PFS(P<0.05). Conclusion The overall CR rate of patients in this center was 92.2%,and the overall complete response rate of the IA group was better than that of the DA group (P=0.036). The course of high-dose cytarabine ≥3 times is a good prognostic factor,with poor prognosis of additional chromosomal abnormalities. Hematopoietic stem cell transplantation can achieve better long-term results.
作者
周文华
纪德香
陈国安
ZHOU Wenhua;CHEN Guoan(Department of Hematology,the First Affiliated Hospital of Nanchang University. Nanchang,330006,China)
出处
《江西医药》
CAS
2019年第2期98-101,143,共5页
Jiangxi Medical Journal
基金
国家自然基金项目
编号81760040
关键词
急性髓系白血病
M2
临床特点
预后
Acute myeloid leukemia
M2
Clinical features
Prognosis
