Niparuck Pimjai, Chuncharunee Suporn, Ungkanont Artit, Udomtrupayakul Umaporn, Aungchaisuksiri Puntep, Rerkamnuatchoke Budsaba, Jootar Saengsuree, Atichartakarn Vichai
Division of Hematology, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
J Med Assoc Thai. 2009 Sep;92(9):1143-9.
Acute myeloid leukemia (AML) is the heterogeneous disease. As per previous reports, there are some differences in clinical features and cytogenetic biomarkers of AML among different ethnic backgrounds. Therefore, we conducted a retrospective study to analyze clinical outcomes and predictive factors of Thai AML patients receiving chemotherapy treatment.
The authors performed a retrospective analysis of 106 adults with newly diagnosed de novo AML at Ramathibodi Hospital between 2003 and 2007. Of 101 patients with non- M3 subtype, the patients received induction and consolidation chemotherapy with anthracyclin plus cytarabine based regimens (3 + 7). All patients achieving complete remission (CR) were treated with intensive chemotherapy using intermediate dose cytarabine plus anthracyclin based protocol. All patients with M3 subtype, the induction chemotherapy consisted of a combination of all-trans retinoic acid (ATRA) and anthracyclin. All patients achieving complete remission (CR) were treated with three courses of mitoxantrone as consolidation chemotherapy, followed by maintenance chemotherapy with methotrexate, etoposide and ATRA.
Of the 106 patients, median age was 43.5 years (15-73 years) and 19 (17.9%) were older than 60 years. Fifty-six patients (52.8%) were female. Common subtypes were M4 (28.3%), M1 (26.4%) and M2 (20.8%). Of the 95 patients who were performed with cytogenetic analysis, 55 (58%) had abnormal karyotype. AML with recurrent cytogenetic translocations, complex chromosome, trisomy 8, polyploidy, del 5q and del 7q were found in 16.8, 6.3, 5.3, 5.3, 2.1 and 3.2%, respectively. Most patients (70.5%) had intermediate-risk cytogenesis. Eighty patients (75.5%) were treated with idarubicin and cytarabine induction regimen. Of the 96 evaluable patients, 60 (62.5%) achieved complete remission (CR), 38 (39.6%) with the first course of chemotherapy. Median time to CR was 54 days (25-168 days). The CR rate was 78.6% for the good-risk cytogenetic group, 67.2% for the intermediate- risk cytogenetic group, and 37.5% for the poor-risk cytogenetic group. Median follow-up time was 10.4 months, 5-year-DFS and 5-year-OS were 41 and 22.2%, respectively. Patients with poor-risk cytogenetic factors had significantly lower CR rate (p = 0.021). The CR status significantly predicted OS (p < 0.001).
The overall complete remission rate of Thai AML patients is in 60%. Only a small proportion of the presented patients have long-term DFS and OS, the significant factor for predicting survival of Thai AML patients is the complete remission status. Poor-risk cytogenetic factors are associated with poor treatment outcomes.
急性髓系白血病（AML）是一种异质性疾病。根据以往报告，不同种族背景的AML患者在临床特征和细胞遗传学生物标志物方面存在一些差异。因此，我们进行了一项回顾性研究，以分析接受化疗的泰国AML患者的临床结局和预测因素。
作者对2003年至2007年间在拉玛蒂博迪医院新诊断为初发AML的106例成人患者进行了回顾性分析。在101例非M3亚型患者中，患者接受了以蒽环类药物加阿糖胞苷为基础的方案（3 + 7）进行诱导和巩固化疗。所有达到完全缓解（CR）的患者均采用含中剂量阿糖胞苷加蒽环类药物的方案进行强化化疗。所有M3亚型患者，诱导化疗采用全反式维甲酸（ATRA）和蒽环类药物联合使用。所有达到完全缓解（CR）的患者均接受三疗程米托蒽醌巩固化疗，随后采用甲氨蝶呤、依托泊苷和ATRA进行维持化疗。
106例患者中，中位年龄为43.5岁（15 - 73岁），19例（17.9%）年龄大于60岁。56例患者（52.8%）为女性。常见亚型为M4（28.3%）、M1（26.4%）和M2（20.8%）。在95例进行细胞遗传学分析的患者中，55例（58%）核型异常。发现伴有复发性细胞遗传学易位、复杂染色体、8号染色体三体、多倍体、5q缺失和7q缺失的AML分别占16.8%、6.3%、5.3%、5.3%、2.1%和3.2%。大多数患者（70.5%）具有中危细胞遗传学特征。80例患者（75.5%）接受了伊达比星和阿糖胞苷诱导方案治疗。在96例可评估患者中，60例（62.5%）达到完全缓解（CR），38例（39.6%）在第一疗程化疗时达到缓解。达到CR的中位时间为54天（25 - 168天）。低危细胞遗传学组的CR率为78.6%，中危细胞遗传学组为67.2%，高危细胞遗传学组为37.5%。中位随访时间为10.4个月，5年无病生存率（DFS）和5年总生存率（OS）分别为41%和22.2%。具有高危细胞遗传学因素的患者CR率显著较低（p = 0.021）。CR状态显著预测OS（p < 0.001）。
泰国AML患者的总体完全缓解率为60%。只有一小部分患者具有长期DFS和OS，预测泰国AML患者生存的重要因素是完全缓解状态。高危细胞遗传学因素与较差的治疗结局相关。
