Jahic Azra, Iljazovic Ermina, Hasic Samira, Arnautovic Aida Custovic, Sabitovic Damir, Mesanovic Semir, Sahovic Haris, Simendic Vlastimir
Clinic for Oncology, Hematology and Radiotherapy, Department of Hematology, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina.
Policlinic for Laboratory Diagnostics, Pathology Department, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina.
Med Arch. 2017 Feb;71(1):20-24. doi: 10.5455/medarh.2017.71.20-24. Epub 2017 Feb 5.
The treatment response and outcome in acute myeloid leukaemia (AML) is heterogeneous.
To analyze the prognostic parameters of AML at presentation.
The total sample of 44 AML patients was analyzed on the basis of age <55 and ≥55 years, sex, WBC count <50x10//l and ≥50x10//l, the Hb concentration <100 g/l and ≥100 g/l, PLT count <100x10//l and ≥100x10//l, Karnofsky score <60% and >60%, cytogenetics, CD56 expression, morphological type and types of treatment (standard and reduced induction chemotherapy, high-dose chemotherapy/stem cell transplantation - autologous and HLA matched, related, allogeneic, together and separately).
The age <55 years, Karnofsky score >60% and standard induction chemotherapy statistically correlated with the higher complete remission (CR) rates, longer relapse free survival (RFS), lower relapse rate (RR), and longer overall survival (OS) (p<0.01). The difference in terms of CR and RR between the sexes were not statistically significant (p<0.05), however women had statistically lower OS comparing to men (9.71±4.54 months vs. 38.03±9.17 months) (p<0.01). WBC count ≥ 50x10//l and the Hb concentration <100 g/l statistically correlated with shorter OS (p<0.05), while the WBC count ≥50x10//l statistically correlated with shorter RFS (p<0.05). The PLT count <100x10//l and ≥100x10//l was not found as prognostically significant for CR, RR, RFS, and OS (p<0.05). In comparison to the standard induction chemotherapy, both types of high dose chemotherapy/stem cell transplantation (HDT/SCT) (10/22), together and separately, resulted in longer RFS, lower RR, and longer OS (p<0.05). The frequency of cytogenetic risk was intermediate 81.6%, unfavorable 13.2%, and favorable 5.3%, respectively. CD56 + expression statistically correlated with the lower PLT count, higher RR, shorter RFS, and shorter OS (p<0.05). Statistical analysis of the cytogenetic risk and morphological types of AML were not possible due to the small number of patients in stratified groups.
Female sex, the WBC count >50x10//l, the concentration of Hb <100 g/l, and CD56 + expression, at presentation of AML, should be considered as parameters of adverse risk, especially in latter decisions considering post-remission treatment with HDT/SCT.
急性髓系白血病（AML）的治疗反应和结果具有异质性。
分析初诊时AML的预后参数。
基于年龄<55岁和≥55岁、性别、白细胞计数<50×10⁹/L和≥50×10⁹/L、血红蛋白浓度<100g/L和≥100g/L、血小板计数<100×10⁹/L和≥100×10⁹/L、卡诺夫斯基评分<60%和>60%、细胞遗传学、CD56表达、形态学类型以及治疗类型（标准诱导化疗和降低强度诱导化疗、大剂量化疗/干细胞移植——自体和人类白细胞抗原匹配、相关、同种异体，联合及单独使用），对44例AML患者的总样本进行分析。
年龄<55岁、卡诺夫斯基评分>60%和标准诱导化疗在统计学上与更高的完全缓解（CR）率、更长的无复发生存期（RFS）、更低的复发率（RR）以及更长的总生存期（OS）相关（p<0.01）。性别在CR和RR方面的差异无统计学意义（p<0.05），然而女性的OS在统计学上低于男性（9.71±4.54个月对38.03±9.17个月）（p<0.01）。白细胞计数≥50×10⁹/L和血红蛋白浓度<100g/L在统计学上与较短的OS相关（p<0.05），而白细胞计数≥50×10⁹/L在统计学上与较短的RFS相关（p<0.05）。血小板计数<100×10⁹/L和≥100×10⁹/L在CR、RR、RFS和OS方面未发现具有预后显著性（p<0.05）。与标准诱导化疗相比，两种类型的大剂量化疗/干细胞移植（HDT/SCT）（10/22），联合及单独使用，均导致更长的RFS、更低的RR以及更长的OS（p<0.05）。细胞遗传学风险频率分别为中等81.6%、不良13.2%和良好5.3%。CD56+表达在统计学上与较低的血小板计数、较高的RR、较短的RFS以及较短的OS相关（p<0.05）。由于分层组中的患者数量较少，无法对AML的细胞遗传学风险和形态学类型进行统计分析。
AML初诊时，女性、白细胞计数>50×10⁹/L、血红蛋白浓度<100g/L以及CD56+表达应被视为不良风险参数，尤其是在考虑缓解后使用HDT/SCT治疗的后续决策中。
