Gajewski J L, Ho W G, Nimer S D, Hirji K F, Gekelman L, Jacobs A D, Champlin R E
Division of Hematology/Oncology University of California, Los Angeles 90024.
J Clin Oncol. 1989 Nov;7(11):1637-45. doi: 10.1200/JCO.1989.7.11.1637.
One hundred ninety-six patients with acute myelogenous leukemia (AML) were treated with intensive induction chemotherapy using similar daunorubicin/cytarabine/thioguanine regimens. Treatment results of 44 patients who had a documented preleukemic syndrome or cytopenia present for more than 2 months before developing over AML were compared with 152 patients with de novo AML. Eighteen (41%) patients with preleukemia evolving into AML achieved complete remission compared with 111 (73%) patients with de novo AML (P less than .01). Patients with preleukemia-AML had a significantly longer period to recovery of granulocytes. Multivariate analysis indicated that presence of a previous preleukemic syndrome and advancing age were independent poor prognostic indicators for achieving remission. For patients who achieved remission, disease-free survival and overall survival were also inferior for patients with previous preleukemia; disease-free survival was 17 +/- 17% at 3 years compared with 29 +/- 10% in patients with de novo AML (P = .02). These data indicate that intensive chemotherapy has limited efficacy in patients with AML following a preleukemic syndrome. Durable remissions may be achieved in some patients.
196例急性髓性白血病（AML）患者接受了使用类似柔红霉素/阿糖胞苷/硫鸟嘌呤方案的强化诱导化疗。将44例在发生AML之前记录有白血病前期综合征或血细胞减少症超过2个月的患者的治疗结果与152例新发AML患者进行了比较。18例（41%）由白血病前期发展为AML的患者实现了完全缓解，而新发AML患者中有111例（73%）实现了完全缓解（P小于0.01）。白血病前期AML患者粒细胞恢复的时间明显更长。多因素分析表明，既往存在白血病前期综合征和年龄增长是实现缓解的独立不良预后指标。对于实现缓解的患者，既往有白血病前期的患者的无病生存期和总生存期也较差；3年时无病生存期为17±17%，而新发AML患者为29±10%（P = 0.02）。这些数据表明，强化化疗对白血病前期综合征后的AML患者疗效有限。部分患者可能实现持久缓解。
