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高原地区初诊急性白血病的临床特征及治疗疗效

[Clinical characteristics and treatment efficacy of newly diagnosed acute leukemia in the plateau].

作者信息

He Q Y, Lai A L, Zhang A, Wang L N, Chen X M, Qiu S W, Wei H, Wang J X, Zhang G J

机构信息

People's Hospital of Tibet Autonomous Region, Lhasa 850000.

State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China.

出版信息

Zhonghua Xue Ye Xue Za Zhi. 2024 Dec 14;45(12):1106-1112. doi: 10.3760/cma.j.cn121090-20240514-00182.

Abstract

This study aimed to retrospectively analyze the clinical characteristics and prognosis of patients with acute leukemia in the plateau. The clinical information of patients diagnosed with acute leukemia from February 2010 to April 2023 at the People's Hospital of Tibet Autonomous Region was reviewed and collected, including blood cell count, morphology, immunophenotype, cytogenetics, and molecular data. Survival analysis was conducted to analyze the outcome of patients with acute leukemia. This study enrolled 105 patients with acute leukemia, including 24 with acute lymphoblastic leukemia (ALL), 62 with acute myeloid leukemia (AML), and 19 with acute leukemia without baseline data. Of the patients with ALL, 11 underwent bone marrow testing for immunophenotype, all of whom were B-cell lineage. The main FAB subtype of patients with AML was M(2) (25/57), followed by M(3) (12/57), M(5) (6/57), M(4EO) (5/57), M(1) (4/57), M(4) (4/57), and M(0) (1/57). The complete remission rates of patients with ALL, acute promyelocytic leukemia (APL), and AML (non-APL) after one course of induction therapy were 57.1% (8/14), 100% (6/6), and 53.6% (15/28), respectively. The median event-free survival (EFS) and overall survival (OS) for patients with ALL were 2 (95% 0-9) and 3 (95% 0-9) months, respectively, with a median followup of 37 (95% 17-57) months. Patients with APL did not reach median EFS or OS, whereas the median EFS and OS for core binding factor AML (CBF-AML) cases were 10 (95% 0-21) months and 13 (95% 3-23) months, respectively, and patients with non-CBF-AML had inferior median EFS (2 months, 95% 1-3) and OS (2 months, 95% 1-3) (<0.01). Patients with ALL treated from 2020 to 2023 demonstrated trends toward better EFS (=0.16) and OS (=0.10) than those treated from 2010 to 2019. Similarly, trends toward superior EFS (=0.27) and OS (=0.12) were observed in patients with AML treated from 2016 to 2023, in comparison with those treated from 2010 to 2015. Progress in the treatment and prognosis of patients with acute leukemia in the plateau has been observed in recent years, which can be further promoted by precision diagnosis and tailored regimens.

摘要

本研究旨在回顾性分析高原地区急性白血病患者的临床特征及预后。回顾并收集了2010年2月至2023年4月在西藏自治区人民医院诊断为急性白血病患者的临床信息,包括血细胞计数、形态学、免疫表型、细胞遗传学和分子数据。进行生存分析以分析急性白血病患者的预后情况。本研究纳入105例急性白血病患者,其中急性淋巴细胞白血病(ALL)24例,急性髓系白血病(AML)62例,19例急性白血病患者无基线数据。在ALL患者中,11例接受了免疫表型的骨髓检测,均为B细胞系。AML患者的主要FAB亚型为M(2)(25/57),其次为M(3)(12/57)、M(5)(6/57)、M(4EO)(5/57)、M(1)(4/57)、M(4)(4/57)和M(0)(1/57)。ALL患者、急性早幼粒细胞白血病(APL)患者和AML(非APL)患者经过一个疗程诱导化疗后的完全缓解率分别为57.1%(8/14)、100%(6/6)和53.6%(15/28)。ALL患者的无事件生存期(EFS)和总生存期(OS)中位数分别为2(95% 0 - 9)个月和3(95% 0 - 9)个月,中位随访时间为37(95% 17 - 57)个月。APL患者未达到EFS或OS中位数,而核心结合因子AML(CBF - AML)病例的EFS和OS中位数分别为10(95% 0 - 21)个月和13(95% 3 - 23)个月,非CBF - AML患者的EFS(2个月,95% 1 - 3)和OS(2个月,95% 1 - 3)中位数较差(<0.01)。2020年至2023年接受治疗的ALL患者与2010年至201年接受治疗的患者相比,EFS(=0.16)和OS(=0.10)有改善趋势。同样,与2010年至2015年接受治疗的AML患者相比观察到,2016年至2023年接受治疗的患者EFS(=0.27)和OS(=0.12)有改善趋势。近年来观察到高原地区急性白血病患者的治疗和预后有进展,精准诊断和个体化方案可进一步促进其发展。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bb5c/11886690/180308b038ea/cjh-45-12-1106-g001.jpg

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