Ma Y R, Zhao T, Ma L, Hu L J, Duan W B, Jiang H, Huang X J, Jiang Q
Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing 100044, China.
Zhonghua Xue Ye Xue Za Zhi. 2022 Aug 14;43(8):644-650. doi: 10.3760/cma.j.issn.0253-2727.2022.08.005.
This study aimed to explore variables associated with remission rate and survival in patients with acute myeloid leukemia (AML) after induction failure and relapse. Data of 373 consecutive patients with AML were analyzed after induction failure and relapse. Binary logistics and the Cox model regression were used to identify variables associated with remission rate and outcomes. In patients with AML after induction failure and relapse, the total CR+CRi rates were 50.6% and 40.3%, respectively; among those who achieved CR/CRi, the 3-year RFS rates were 34.4% and 30.4%, respectively, and the 3-year overall survival rates were 40.1% and 31.6%, respectively. In the multivariate analyses, using CLAG or FLAG regimen as a re-induction chemotherapy regimen, age <39 years and SWOG low-risk were significantly associated with higher remission rates in patients with induction failure. Male, secondary AML, SWOG high-risk, the interval from the first remission to relapse within 12 months, and bone marrow blasts ≥20% at the time of relapse were significantly associated with lower remission rates in relapsed patients. Transplantation was significantly associated with prolonged relapse-free survival and overall survival in patients achieving hematologic remission; the SWOG low-risk group was significantly associated with longer overall survival in those with induction failure; and achieving CR (not CRi) or having female gender was associated with longer RFS or overall survival in relapsed patients. Reinduction chemotherapy regimen, age, gender, SWOG risk, secondary AML, the interval from the first remission to relapse, and bone marrow blast percentage at the time of relapse were significantly associated with remission rates in the patients with AML after induction failure and relapse. Transplantation, SWOG low-risk, achieving CR, or female gender were associated with longer survivals in those achieving remission.
本研究旨在探讨与急性髓系白血病（AML）患者诱导治疗失败和复发后的缓解率及生存率相关的变量。对373例连续的AML患者诱导治疗失败和复发后的资料进行分析。采用二元逻辑回归和Cox模型回归来确定与缓解率及预后相关的变量。在诱导治疗失败和复发的AML患者中，总完全缓解（CR）+部分缓解（CRi）率分别为50.6%和40.3%；在达到CR/CRi的患者中，3年无复发生存率（RFS）分别为34.4%和30.4%，3年总生存率分别为40.1%和31.6%。在多变量分析中，采用CLAG或FLAG方案作为再诱导化疗方案、年龄<39岁以及SWOG低危与诱导治疗失败患者的较高缓解率显著相关。男性、继发性AML、SWOG高危、首次缓解至复发间隔在12个月内以及复发时骨髓原始细胞≥20%与复发患者的较低缓解率显著相关。移植与血液学缓解患者的无复发生存期和总生存期延长显著相关；SWOG低危组与诱导治疗失败患者的较长总生存期显著相关；达到CR（而非CRi）或女性与复发患者较长的RFS或总生存期相关。再诱导化疗方案、年龄、性别、SWOG风险、继发性AML、首次缓解至复发间隔以及复发时骨髓原始细胞百分比与诱导治疗失败和复发的AML患者的缓解率显著相关。移植、SWOG低危、达到CR或女性与缓解患者的较长生存期相关。
