Division of Internal Medicine, Department of Hematology, Dr. José E. González University Hospital of the School of Medicine of the Universidad Autónoma de Nuevo León, Monterrey, México.
Division of Internal Medicine, Department of Hematology, Dr. José E. González University Hospital of the School of Medicine of the Universidad Autónoma de Nuevo León, Monterrey, México.
Clin Lymphoma Myeloma Leuk. 2018 Apr;18(4):286-292. doi: 10.1016/j.clml.2018.02.002. Epub 2018 Feb 8.
The outcomes for adolescents and young adults (AYAs) with acute myeloid leukemia (AML) have been poorly characterized in Hispanics in low- to middle-income countries. The results are influenced by biologic and socioeconomic factors. The clinical paths for AYA patients with AML are reported.
A retrospective analysis of AYA and pediatric AML patients aged 1 to 39 years during 2003 to 2016 from a single reference center in Northeast Mexico treated with a 7+3 standard protocol was performed. The 5-year overall survival (OS) and event-free survival (EFS) were estimated using Kaplan-Meier analysis. The hazard ratios for relapse and death were estimated using a Cox regression model. The patients with promyelocytic leukemia were analyzed separately.
The study included 110 non-PML AML patients, 39 children and 71 AYAs. No difference in complete remission was found (P = .446), although the overall response rate was greater in the children (87.2% vs. 69% in AYAs; P = .034). The 5-year EFS rate was 33% for the children versus 9.3% in the AYAs at a median follow-up of 22 and 9 months, respectively (P = .008). The 5-year OS rate was 51% in the children and 22% in the AYAs (P = .001). Of the 44 AYAs with complete remission, 29 (65%) developed a relapse. Of the 39 children and 71 AYAs, 20 children (51.3%) and 21 AYAs (29.6%) underwent transplantation (P = .024). Patients with refractory disease had a 1-year OS rate of 14.4%. Older age (hazard ratio [HR], 2.55; P = .002) and white blood cell count > 50 × 10/L (HR, 1.79; P = .023) were significant for death, and transplantation was protective (HR, 0.57; P = .023).
Low EFS and OS rates were found for AML patients in the AYA group. To improve survival rates, intensified chemotherapy regimens and early hematopoietic stem cell transplantation are needed.
在中低收入国家，西班牙裔青少年和年轻人（AYAs）的急性髓系白血病（AML）的预后特征很差。结果受生物学和社会经济因素的影响。报告了 AYA 患者 AML 的临床路径。
对 2003 年至 2016 年期间在墨西哥东北部单一参考中心接受 7+3 标准方案治疗的年龄在 1 至 39 岁的 AYA 和儿科 AML 患者进行了回顾性分析。采用 Kaplan-Meier 分析估计 5 年总生存率（OS）和无事件生存率（EFS）。采用 Cox 回归模型估计复发和死亡的风险比。单独分析早幼粒细胞白血病患者。
该研究包括 110 例非 PML AML 患者，其中 39 例为儿童，71 例为 AYA。完全缓解率无差异（P=0.446），尽管儿童的总缓解率更高（87.2%对 AYA 的 69%；P=0.034）。中位随访 22 和 9 个月时，儿童的 5 年 EFS 率为 33%，而 AYA 的 5 年 EFS 率为 9.3%（P=0.008）。儿童的 5 年 OS 率为 51%，而 AYA 的为 22%（P=0.001）。在 44 例完全缓解的 AYA 中，29 例（65%）复发。在 39 名儿童和 71 名 AYA 中，20 名儿童（51.3%）和 21 名 AYA（29.6%）接受了移植（P=0.024）。难治性疾病患者的 1 年 OS 率为 14.4%。年龄较大（危险比[HR]，2.55；P=0.002）和白细胞计数>50×10/L（HR，1.79；P=0.023）与死亡相关，而移植具有保护作用（HR，0.57；P=0.023）。
AYA 组 AML 患者的 EFS 和 OS 率较低。为了提高生存率，需要强化化疗方案和早期造血干细胞移植。
