Jiang Bo, Mi Ying-Chang, Lin Dong, Cai Xiao-Jin, Fu Ming-Wei, Li Wei, Wang Ying, Liu Xu-Ping, Xue Yan-Ping, Bian Shou-Geng, Wang Jian-Xiang
Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin 300020, China.
Zhonghua Nei Ke Za Zhi. 2009 Apr;48(4):316-20.
To evaluate the impact of the percentage of residual blasts in bone marrow at the end of induction chemotherapy (T1) or during myelosuppression phase (T2) on prognosis of de novo acute myeloid leukemia (AML) (non M(3)) in 105 cases. To refine AML risk-stratification by combining the percentage of residual blast cells (T1 or/and T2) with cytogenetic data based the South West Oncology Group (SWOG) criteria.
The data of 105 de novo AML (non M(3)) patients hospitalized between January 1st 1999 and February 1st 2008 were retrospectively reviewed. Results were analyzed with SPSS15.0 software.
(1) Patients were divided into two subgroups by a cutoff of 5% residual bone marrow blasts at T1 or T2 time point. Patients with percentage of residual bone marrow blast cells < 5% had better complete remission (CR) rate, relapse-free survival (RFS) and overall survival (OS) than the patients with percentage > or = 5% at T1 or T2. The percentage of residual bone marrow blast cells at T1 was correlated with that at T2. (2) The prognosis of patients with intermediate karyotypes with percentage < 5% at T1 or T2 was similar to that of the patients with favorable karyotypes. The patients with intermediate karyotypes and percentage of residual bone marrow blasts > or = 5% at T1 or T2 are defined as a subgroup with prognosis similar to that of patients with unfavorable karyotypes. (3) COX regression analysis showed that the percentage of residual bone marrow blasts at T1 or T2 is an independent prognostic factor of AML. The percentage of residual bone marrow blasts at T1 may be more helpful in prognostication than that at T2.
AML patients with percentage of residual bone marrow blasts < 5% after induction chemotherapy (T1 or T2) have better CR rate, RFS, OS than the patients with percentage > or = 5% at the same time point. Combination of cytogenetics and percentage of residual bone marrow blasts at T1 or T2 is helpful to divide patients with intermediate karyotypes into two subgroups with different prognosis. Thus, a better decision of treatment strategy can be designed.
评估105例初发急性髓系白血病（AML，非M(3)型）患者诱导化疗结束时（T1）或骨髓抑制期（T2）骨髓中残留原始细胞百分比对预后的影响。基于西南肿瘤协作组（SWOG）标准，将残留原始细胞百分比（T1或/和T2）与细胞遗传学数据相结合，完善AML的危险分层。
回顾性分析1999年1月1日至2008年2月1日期间住院的105例初发AML（非M(3)型）患者的数据。采用SPSS15.0软件进行结果分析。
（1）以T1或T2时间点骨髓残留原始细胞5%为界值将患者分为两个亚组。骨髓残留原始细胞百分比<5%的患者较T1或T2时百分比≥5%的患者有更好的完全缓解（CR）率、无复发生存（RFS）和总生存（OS）。T1时骨髓残留原始细胞百分比与T2时相关。（2）T1或T2时残留原始细胞百分比<5%的中危核型患者预后与预后良好核型患者相似。T1或T2时中危核型且骨髓残留原始细胞百分比≥5%的患者被定义为一个预后与预后不良核型患者相似的亚组。（3）COX回归分析显示，T1或T2时骨髓残留原始细胞百分比是AML的独立预后因素。T1时骨髓残留原始细胞百分比在预后判断中可能比T2时更有帮助。
诱导化疗后（T1或T2）骨髓残留原始细胞百分比<5%的AML患者较同时点百分比≥5%的患者有更好的CR率、RFS和OS。将细胞遗传学与T1或T2时骨髓残留原始细胞百分比相结合有助于将中危核型患者分为两个预后不同的亚组。因此，可以制定更好的治疗策略决策。
