Nasir Syed Sameer, Giri Smith, Nunnery Sara, Martin Mike G
Division of Hematology and Oncology, Department of Medicine, University of Health Science Center, Memphis, TN; The West Cancer Center, Memphis, TN.
Department of Medicine, University of Tennessee Health Science Center, Memphis, TN.
Clin Lymphoma Myeloma Leuk. 2017 Feb;17(2):126-132.e1. doi: 10.1016/j.clml.2016.09.011. Epub 2016 Sep 17.
Studies on the outcome of adolescents and young adults (AYAs) with acute myeloid leukemia (AML) and acute promyelocytic leukemia (APL) are limited.
We compared the outcome of AYA (19-30 years) patients with AML and PML and pediatric (0-18 years) patients with AML (pAMLs) and APL (pAPLs) utilizing the Surveillance Epidemiology and End Results-18 registry. Early mortality rate (EMR), defined as mortality within 1 month of diagnosis, was used as a surrogate for treatment-related mortality. Survival statistics were computed using the Kaplan-Meier method. Multivariate analysis was done using logistic regression and the Cox proportional hazard regression model.
A total of 6343 patients with AML were identified; 44.7% were AYAs. pAMLs had lower EMR (6.2% vs. 9.2%; P < .01) and higher overall survival (OS) (1-year, 70.3% vs. 62.1%; 5-year, 48.2% vs. 36.4%; P < .01). Nine hundred twenty patients with APL were also identified; 59.5% were AYAs. No statistically significant difference was found between AYAs with APL and pAPLs in EMR (11.4% vs. 14.1%; P = .23) and OS (1-year, 83.8% vs. 81.2%; P = .31 and 5-year, 68.2% vs. 73.1%; P = .11]. Comparing all patients with AML and APL, AYAs with APL and pAPLs had higher EMR (11.4% and 14.1% vs. 6.2% and 9.2%; P ≤ .01) but better OS than AYAs with AML and pAMLs (5-year OS, 68.2% and 73.1% vs. 48.2% and 36.4%; P ≤ .01).
Our analysis shows AYAs with AML have worse EMR and OS compared with pAMLs. AYAs with APL and pAPLs have similar outcomes. To our knowledge, this is the first study reporting outcomes of AYAs with APL and pAPLs using a large population-based registry and their comparison with same age patients with AML.
关于青少年及青年（AYA，年龄19 - 30岁）急性髓系白血病（AML）和急性早幼粒细胞白血病（APL）预后的研究有限。
我们利用监测、流行病学与最终结果-18登记系统，比较了AYA（19 - 30岁）AML和APL患者与儿科（0 - 18岁）AML（pAML）和APL（pAPL）患者的预后。早期死亡率（EMR，定义为诊断后1个月内的死亡率）被用作治疗相关死亡率的替代指标。生存统计采用Kaplan-Meier方法计算。多变量分析采用逻辑回归和Cox比例风险回归模型。
共识别出6343例AML患者；44.7%为AYA患者。pAML患者的EMR较低（6.2%对9.2%；P <.01），总生存期（OS）较高（1年时，70.3%对62.1%；5年时，48.2%对36.4%；P <.01）。还识别出920例APL患者；59.5%为AYA患者。AYA-APL患者与pAPL患者在EMR（11.4%对14.1%；P =.23）和OS（1年时，83.8%对81.2%；P =.31；5年时，68.2%对73.1%；P =.11）方面未发现统计学显著差异。比较所有AML和APL患者，AYA-APL患者与pAPL患者的EMR较高（11.4%和14.1%对6.2%和9.2%；P≤.01），但OS优于AYA-AML患者与pAML患者（5年OS，68.2%和73.1%对48.2%和36.4%；P≤.01）。
我们的分析表明，与pAML患者相比，AYA-AML患者的EMR和OS更差。AYA-APL患者与pAPL患者的预后相似。据我们所知，这是第一项使用基于大人群的登记系统报告AYA-APL患者和pAPL患者预后及其与同年龄AML患者比较的研究。
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