Estienne M H, Fenaux P, Preudhomme C, Lai J L, Zandecki M, Lepelley P, Cosson A
Laboratoire d'Hématologie, Centre Hospitalier et Universitaire de Lille, France.
Clin Lab Haematol. 1990;12(1):57-65. doi: 10.1111/j.1365-2257.1990.tb01111.x.
The prognostic value of cytological features was assessed in 132 patients with de novo acute myeloid leukaemia (AML) treated by anthracycline-cytosine-arabinoside combination chemotherapy. Of these patients, 98 (75%) achieved complete remission (CR). A significantly lower CR rate was seen in patients with trilineage dysmyelopoiesis (TDMP) (P = 0.003), but not in patients with dyserythropoiesis and/or dysgranulopoiesis without abnormal megakaryocytes. Other unfavourable factors were age greater than 50 years (P = 0.042), leucocyte count greater than 100 x 10(9)/l (P = 0.006), M5 FAB subtype (P = 0.013), presence of complex cytogenetic rearrangement or abnormalities of chromosome 5 and/or 7 (P = 0.001). Bone marrow eosinophilia greater than 3% was significantly associated with a higher CR rate (P = 0.04). In a multivariate analysis, a low CR rate was best predicted by the presence of a complex karyotype or abnormalities of chromosome 5 and/or 7 (P = 0.0001) and by the TDMP (P = 0.0036). Median actuarial disease-free survival (DFS) was 24 months. Actuarial DFS was significantly shorter in patients with TDMP (P = 0.0001) and an elevated leucocyte count (P = 0.02). Age, FAB subtype and karyotype had no significant incidence on DFS. Presence of TDMP appears to be an important prognostic factor in de novo AML. This could be used as one of the guidelines to therapy.
对132例接受蒽环类药物-阿糖胞苷联合化疗的初发性急性髓系白血病（AML）患者的细胞学特征的预后价值进行了评估。这些患者中，98例（75%）实现了完全缓解（CR）。三系髓系发育异常（TDMP）患者的CR率显著较低（P = 0.003），但无异常巨核细胞的红系发育异常和/或粒系发育异常患者的CR率并无显著差异。其他不良因素包括年龄大于50岁（P = 0.042）、白细胞计数大于100×10⁹/L（P = 0.006）、M5 FAB亚型（P = 0.013）、存在复杂细胞遗传学重排或5号和/或7号染色体异常（P = 0.001）。骨髓嗜酸性粒细胞增多大于3%与较高的CR率显著相关（P = 0.04）。在多变量分析中，复杂核型或5号和/或7号染色体异常（P = 0.0001）以及TDMP（P = 0.0036）最能预测CR率较低。中位精算无病生存期（DFS）为24个月。TDMP患者（P = 0.0001）和白细胞计数升高患者（P = 0.02）的精算DFS显著缩短。年龄、FAB亚型和核型对DFS无显著影响。TDMP的存在似乎是初发性AML的一个重要预后因素。这可作为治疗指南之一。
