[儿童急性髓系白血病预后变量分析]
[Analysis of prognostic variables in childhood acute myeloid leukemia].
作者信息
Gu Long-jun, Tie Li-jun, Xue Hui-liang, Tang Jing-yan, Chen Jing, Pan Ci, Chen Jing, Ye Hui, Wang Yao-ping, Dong Lu
机构信息
Department of Hematology/Oncology, the Affiliated Xinhua Hospital/Shanghai Children's Medical Center, Medical College of Jiao Tong University, Shanghai 200127, China.
出版信息
Zhonghua Xue Ye Xue Za Zhi. 2006 Jan;27(1):10-3.
OBJECTIVE
To assess the prognostic value of the biological features and therapy-related factors in childhood acute myeloid leukemia (AML).
METHODS
From January 1998 to May 2003, 75 patients with newly diagnosed AML were enrolled on the protocol AML-XH-99. Biological features at presentation [gender, age, white blood cells, platelet count, French-American-British (FAB) subtypes, cytogenetic abnormalities] and therapy-related factors [bone marrow (BM) blast cell counts at 48 h after the first induction course, complete remission (CR) rate after the first course of induction therapy] were analyzed. The probability of event-free survival (pEFS) was estimated by Kaplan-Meier analysis and the distributions of pEFS were compared using log-rank test. Chi-square analysis or Fisher exact test was used to compare differences in the distribution of presenting biological features. A Cox proportional hazards model was used to identify independent prognostic factors.
RESULTS
(1) Univariate analysis of the proportion of patients attaining CR after induction indicate that FAB M(5), BM blasts >or= 0.150 at 48 h after the first induction course and no response to the first induction course were associated with lower CR rates (P = 0.001, 0.011, 0.000 respectively). Univariate analysis also demonstrated that the 5-year pEFS for patients with age < 1 year or > 10 years, platelet count < 20 x 10(9)/L, FAB M(5), hepatomegaly, BM blasts >or= 0.150 at 48 h after the first induction course and no response to the first induction course, central nervous system (CNS) leukemia was unfavorable, while the outcome of patients with cytogenetic abnormalities of t (8; 21) or t (15; 17) were better. (2) Multivariate analysis suggested that cytogenetic abnormality of t (15; 17), achieved CR after the first induction course and no CNS leukemia were independent favorable prognostic factors.
CONCLUSIONS
Combined analysis of cytogenetic abnormalities with early treatment response has an important prognostic significance, and can predict outcomes.
目的
评估生物学特征和治疗相关因素在儿童急性髓系白血病（AML）中的预后价值。
方法
1998年1月至2003年5月，75例新诊断的AML患者纳入AML-XH-99方案。分析初诊时的生物学特征[性别、年龄、白细胞、血小板计数、法美英（FAB）亚型、细胞遗传学异常]和治疗相关因素[首次诱导疗程后48小时的骨髓（BM）原始细胞计数、首次诱导治疗疗程后的完全缓解（CR）率]。采用Kaplan-Meier分析估计无事件生存概率（pEFS），并使用对数秩检验比较pEFS的分布。采用卡方分析或Fisher精确检验比较初诊生物学特征分布的差异。使用Cox比例风险模型识别独立的预后因素。
结果
（1）诱导后达到CR的患者比例的单因素分析表明，FAB M(5)、首次诱导疗程后48小时BM原始细胞≥0.150以及对首次诱导疗程无反应与较低的CR率相关（分别为P = 0.001、0.011、0.000）。单因素分析还表明，年龄＜1岁或＞10岁、血小板计数＜20×10⁹/L、FAB M(5)、肝肿大、首次诱导疗程后48小时BM原始细胞≥0.150以及对首次诱导疗程无反应、中枢神经系统（CNS）白血病的患者5年pEFS不佳，而具有t(8;21)或t(15;17)细胞遗传学异常的患者结局较好。（2）多因素分析表明，t(15;17)细胞遗传学异常、首次诱导疗程后达到CR以及无CNS白血病是独立的有利预后因素。
结论
细胞遗传学异常与早期治疗反应的联合分析具有重要的预后意义，且可预测结局。
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