Kantarjian H M, Smith T L, McCredie K B, Keating M J, Walters R S, Talpaz M, Hester J P, Bligham G, Gehan E, Freireich E J
Blood. 1985 Dec;66(6):1326-35.
The prognostic importance of patient pretreatment clinical and laboratory features was investigated in a group of 303 patients with Philadelphia chromosome-positive benign-phase chronic myelogenous leukemia. Intensive chemotherapy was given to 97 patients, and 78 underwent an early elective splenectomy. The overall median survival time, dated from hospital admission, was 39 months. Patient characteristics associated with shortened survival were age 60 years or older, black race, the presence of hepatomegaly, splenomegaly, symptoms, weight loss, and poor performance status. Adverse blood and bone marrow parameters were anemia, thrombocytosis or thrombocytopenia, a high proportion of peripheral blasts plus promyelocytes or of basophils, a high proportion of marrow blasts or basophils, decreased marrow megakaryocytes, and cytogenetic abnormalities in addition to the Philadelphia chromosome. Several of these factors were interrelated. A multivariate regression analysis demonstrated that the combination blood basophilia, race, additional cytogenetic abnormalities, age and marrow basophilia had the strongest predictive relationship to survival time. This resulted in a model segregating patients into low-, intermediate-, and high-risk groups, with median survivals of 53, 39, and 25 months, respectively. Another model was derived that did not include the marrow features and identified splenomegaly and platelet counts as adding to the prognosis prediction by blood basophilia, race, and age. Evaluation of the effect of therapy, after adjusting for differences in prognostic characteristics, showed that intensive chemotherapy was associated with survival prolongation among patients at intermediate and high risk of death. We conclude that a combination of pretreatment factors identifies different risk subcategories in patients with chronic myelogenous leukemia and is helpful in assessing overall prognosis and treatment effect.
在一组303例费城染色体阳性的良性期慢性粒细胞白血病患者中，研究了患者预处理时的临床和实验室特征的预后重要性。97例患者接受了强化化疗，78例接受了早期选择性脾切除术。从入院起计算的总体中位生存时间为39个月。与生存时间缩短相关的患者特征包括年龄60岁或以上、黑人种族、存在肝肿大、脾肿大、症状、体重减轻和体能状态差。不良的血液和骨髓参数包括贫血、血小板增多或血小板减少、外周血原始细胞加早幼粒细胞或嗜碱性粒细胞比例高、骨髓原始细胞或嗜碱性粒细胞比例高、骨髓巨核细胞减少以及除费城染色体外的细胞遗传学异常。其中几个因素相互关联。多变量回归分析表明，血液嗜碱性粒细胞增多、种族、额外的细胞遗传学异常、年龄和骨髓嗜碱性粒细胞增多的组合与生存时间的预测关系最强。这产生了一个将患者分为低、中、高风险组的模型，中位生存期分别为53、39和25个月。另一个模型不包括骨髓特征，确定脾肿大和血小板计数可增加血液嗜碱性粒细胞增多、种族和年龄对预后的预测。在调整预后特征差异后评估治疗效果，结果显示强化化疗与中、高死亡风险患者的生存延长相关。我们得出结论，预处理因素的组合可识别慢性粒细胞白血病患者的不同风险亚组，有助于评估总体预后和治疗效果。
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