Keating M J, Smith T L, Gehan E A, McCredie K B, Bodey G P, Freireich E J
Cancer. 1982 Aug 1;50(3):457-65. doi: 10.1002/1097-0142(19820801)50:3<457::aid-cncr2820500313>3.0.co;2-k.
The pretreatment characteristics of 325 adults with acute leukemia who were treated at the M. D. Anderson Hospital between 1973 and 1977 have been evaluated to assess their value as prognostic indicators. The patient population includes all patients treated with an anthracycline (Adriamycin or rubidazone), cytosine arabinoside, vincristine, and prednisone during the time period. Most patients had one of the variants of acute myelogenous leukemia (75%), and the remaining patients had acute lymphoblastic leukemia (16%) or undifferentiated leukemia (8%). Twenty-one factors were found to be significantly associated with probability of obtaining a complete response. In addition to characteristics previously known to provide prognostic information such as age, temperature status at the start of treatment, morphology, the presence of Auer rods, sex, and hemoglobin level, we identified the presence of a documented antecedent hematologic disorder and the finding of insufficient metaphases on cytogenetic analysis using the squash technique as being major prognostic variables. In addition, the pretreatment biochemical characteristics of hypoalbuminemia and elevated blood urea nitrogen and creatinine were found to adversely influence prognosis. The prognostic significance of factors such as the leukocyte count and platelet count, identified in earlier studies, was not confirmed in this group of patients. From this natural-history analysis predictive models for response have been developed using multivariate logistic regression techniques. One of these models has been used to evaluate the effect of morphology, treatment, and cytogenetic pattern on response to the combination of drugs used.
对1973年至1977年间在MD安德森医院接受治疗的325例成年急性白血病患者的预处理特征进行了评估，以评估其作为预后指标的价值。患者群体包括在此期间接受蒽环类药物（阿霉素或柔红霉素）、阿糖胞苷、长春新碱和泼尼松治疗的所有患者。大多数患者患有急性髓性白血病的一种变体（75%），其余患者患有急性淋巴细胞白血病（16%）或未分化白血病（8%）。发现有21个因素与获得完全缓解的概率显著相关。除了先前已知可提供预后信息的特征，如年龄、治疗开始时的体温状况、形态学、奥氏小体的存在、性别和血红蛋白水平外，我们还确定有记录的既往血液系统疾病的存在以及使用压片技术进行细胞遗传学分析时中期分裂相不足的发现是主要的预后变量。此外，还发现预处理时的低白蛋白血症、血尿素氮和肌酐升高的生化特征对预后有不利影响。在这组患者中，早期研究中确定的白细胞计数和血小板计数等因素的预后意义未得到证实。通过多变量逻辑回归技术，从这种自然史分析中建立了反应预测模型。其中一个模型已用于评估形态学、治疗和细胞遗传学模式对所用药物联合治疗反应的影响。
