Service d'Hématologie Clinique, CHU and Université de Nantes, INSERM U892, Nantes, France.
Leukemia. 2011 Jun;25(6):939-44. doi: 10.1038/leu.2011.25. Epub 2011 Feb 18.
A simplified prognostic score is presented based on the multivariate analysis of 138 refractory/relapsed acute myeloid leukaemia (AML) patients (median age 55 years, range: 19-70) receiving a combination of intensive chemotherapy+Gemtuzumab as salvage regimen. Overall, 2-year event-free survival (EFS) and overall survival (OS) were 29±4% and 36±4%, respectively. Disease status (relapse <12 months, including refractory patients), FLT3-ITD-positive status and high-risk cytogenetics were the three strongest independent adverse prognostic factors for OS and EFS in this series. We then defined three subgroups with striking different outcomes at 2 years: no adverse factor (favourable, N=36): OS 58%, EFS 45%; one adverse factor (intermediate, N=54): OS 37%, EFS 31%; two or three adverse factors (poor, N=43): OS 12%, EFS 12% (P<10(-4), P=0.001). This new simplified Leukemia Prognostic Scoring System was then validated on an independent cohort of 111 refractory/relapsed AML patients. This new simplified prognostic score, using three clinical and biological parameters routinely applied, allow to discriminate around two third of the patients who should benefit from a salvage intensive regimen in the setting of refractory/relapsed AML patients. The other one third of the patients should receive investigational therapy.
基于对 138 例难治/复发急性髓系白血病 (AML) 患者 (中位年龄 55 岁，范围：19-70) 的多变量分析，提出了一种简化的预后评分，这些患者接受强化化疗+吉妥珠单抗作为挽救性治疗方案。总体而言，2 年无事件生存率 (EFS) 和总生存率 (OS) 分别为 29±4%和 36±4%。在本系列中，疾病状态 (复发<12 个月，包括难治性患者)、FLT3-ITD 阳性状态和高危细胞遗传学是 OS 和 EFS 的三个最强独立不良预后因素。然后，我们在 2 年内将三个具有显著不同结果的亚组定义为：无不良因素 (有利，N=36)：OS 58%，EFS 45%；一个不良因素 (中等，N=54)：OS 37%，EFS 31%；两个或三个不良因素 (差，N=43)：OS 12%，EFS 12%（P<10(-4)，P=0.001）。然后在 111 例难治/复发 AML 患者的独立队列中验证了这种新的简化白血病预后评分系统。这种新的简化预后评分使用三个常规应用的临床和生物学参数，可以区分大约三分之二的患者，这些患者应该从难治/复发 AML 患者的挽救性强化治疗方案中获益。其余三分之一的患者应接受试验性治疗。
