摘要
目的:探讨既往病史对急性髓系白血病(acute myeloid leukemia,AML)临床预后的影响。方法 :回顾性分析2013年至2017年在我院就诊的119例AML患者,并进行为期2年的随访,分析其临床特点。结果:15例治疗相关性AML(therapy-related AML,t-AML)患者的中位年龄为58.0岁,原发肿瘤以乳腺导管腺癌(53.3%)为主,经治疗后58.3%的患者获得了完全缓解(complete remission,CR),中位总生存(overall survival,OS)时间为12.4(1.1,17.2)个月,获得CR的患者中位无白血病生存(leukemia-free survival,LFS)时间为9.1(4.5,20.7)个月。34例继发于既往血液系统疾病的AML(antecedent hematologic disorder-AML,AHD-AML)患者中位年龄为56.5岁,既往血液系统疾病以骨髓增生异常综合征(myelodysplastic syndromes,MDS)为主(64.7%),经治疗后66.7%的患者获得了CR,其中位OS时间为22.5(5.0,24.0)个月,中位LFS时间为22.3(1.9,22.7)个月。70例初发AML患者的中位年龄为42.0岁,经治疗后80.0%的患者获得了CR,其中位OS时间为24.0(12.3,24.0)个月,中位LFS时间为22.3(16.9,22.7)个月。其中,t-AML患者的OS较AHD-AML(P=0.039)及初发AML(P=0.001)患者均差,三者之间的CR率和LFS则差异无统计学意义。结论:既往有恶性肿瘤病史并接受过细胞毒治疗的患者临床预后较差,应引起重视。
Objective To investigate the influence of antecedent diseases on the prognosis acute myeloid leukemia(AML). Methods A total of 119 AML patients diagnosed and treated at our hospital between 2013-2017 were analyzed retrospectively. Results The median age of 15 therapy-related AML(t-AML) patients was 58.0 years, the majority(53.3%)had breast cancer as primary cancer. Chemotherapy achieved complete remission(CR) in 58.3% patients, who had a median overall survival(OS) of 12.4(1.1, 17.2) months and median leukemia-free survival(LFS) of 9.1(4.5, 20.7) months. The median age of 34 antecedent hematologic disorder-AML(AHD-AML) patients was 56.5 years, with myelodysplastic syndromes(MDS) as the major antecedent hematologic disorder(64.7%). In the patients(66.7%) achieving CR, the median OS and LFS were 22.5(5.0, 24.0) and 22.3(1.9, 22.7) months respectively. The median age of 70 de novo AML patients was42.0 years and 80.0% of patients achieved CR, maintaining a median OS of 24.0(12.3, 24.0) months and median LFS of22.3(16.9, 22.7) months. T-AML patients have a significantly shorter OS in comparison with both AHD-AML patients(P=0.039) and de novo AML patients(P=0.001), while the CR rate and LFS are similar among the three groups. Conclusions The antecedent malignant tumor and cytotoxic therapy bode poorly for AML patients.
作者
董悦昕
李啸扬
张赟翔
李军民
DONG Yuexin;LI Xiaoyang;ZHANG Yunxiang;LI Junmin(Shanghai Institute of Hematology,Department of Hematology,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China)
出处
《内科理论与实践》
2019年第6期361-365,共5页
Journal of Internal Medicine Concepts & Practice
