诱导治疗反应对儿童核心结合因子急性髓系白血病患者预后的影响
[The Impact of Induction Treatment Response on the Prognosis of Pediatric Core Binding Factor-Acute Myeloid Leukemia Patients].
作者信息
Zeng Hui-Min, Hu Guan-Hua, Lu Ai-Dong, Jia Yue-Ping, Zuo Ying-Xi, Wu Jun, Zhang Le-Ping
机构信息
Department of Pediatrics, People's Hospital Peking University, Beijing 100044, China.
Department of Pediatrics, People's Hospital Peking University, Beijing 100044, China,E-mail：
出版信息
Zhongguo Shi Yan Xue Ye Xue Za Zhi. 2021 Feb;29(1):56-61. doi: 10.19746/j.cnki.issn.1009-2137.2021.01.009.
OBJECTIVE
To explore the impact of induction treatment response on the prognosis of pediatric core binding factor-acute myeloid leukemia (CBF-AML).
METHODS
The result of induce reaction and survival data of 157 pediatric CBF-AML patients in our hospital from September 2008 to December 2018 were retrospectively analyzed．The survival rate of the patients with different degrees of morphological remission after induction chemotherapy was comparative analyzed.
RESULTS
Among the 157 children with CBF-AML, 113 (72.4%) patients achieved morphologic leukemia-free state (MLFS) after the first course of induction chemotherapy, 153 (98.1%) patients achieved MLFS after the second course of induction chemotherapy. The 5-year event-free survival (EFS) rate and 5-year overall survival (OS) rate of patients with non-remission (NR) status after the first course of induction of chemotherapy was significantly lower than the patients achieved MLFS and the patients achieved partial remission (PR). The 5-year EFS rate and 5-year OS rate of the patients with PR status after the second course of induction chemotherapy were lower than the patients achieved MLFS, but the difference was not statistically significant. Multivariable analyze showed that NR after the first course of induction chemotherapy and myeloid sarcoma were the independent risk factors affecting EFS of the patients. There were six patients with NR status after the first course of induction chemotherapy, in which all of them harbored t(8;21), three of them with sex chromosome deletion, two of them with myeloid sarcoma.
CONCLUSION
NR status after the first course of induction chemotherapy was the independent risk factor affecting EFS and OS of CBF-AML patients, it can be taken as an indicator for higher risk stratification. PR status after the first course of induction chemotherapy may not be used as a diagnostic criterion for primary drug resistance.
目的
探讨诱导治疗反应对儿童核心结合因子急性髓系白血病（CBF-AML）预后的影响。
方法
回顾性分析2008年9月至2018年12月我院157例儿童CBF-AML患者的诱导反应结果及生存数据。比较分析诱导化疗后不同程度形态学缓解患者的生存率。
结果
157例儿童CBF-AML患者中，113例（72.4%）在第1疗程诱导化疗后达到形态学无白血病状态（MLFS），153例（98.1%）在第2疗程诱导化疗后达到MLFS。第1疗程诱导化疗后未缓解（NR）状态患者的5年无事件生存（EFS）率和5年总生存（OS）率显著低于达到MLFS的患者和达到部分缓解（PR）的患者。第2疗程诱导化疗后PR状态患者的5年EFS率和5年OS率低于达到MLFS的患者，但差异无统计学意义。多变量分析显示，第1疗程诱导化疗后NR和髓系肉瘤是影响患者EFS的独立危险因素。第1疗程诱导化疗后有6例NR状态患者，其中均携带t(8;21)，3例有性染色体缺失，2例有髓系肉瘤。
结论
第1疗程诱导化疗后NR状态是影响CBF-AML患者EFS和OS的独立危险因素，可作为更高风险分层的指标。第1疗程诱导化疗后PR状态可能不能作为原发性耐药的诊断标准。
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