Iwabuchi A, Ohyashiki K, Ohyashiki J H, Kimura Y, Lin K Y, Aizawa S, Nehashi Y, Miyazawa K, Yaguchi M, Toyama K
First Department of Internal Medicine, Tokyo Medical College, Japan.
Int J Hematol. 1994 Oct;60(3):207-13.
We statistically analyzed the hematologic findings of patients with refractory anemia (RA) to identify parameters associated with a poor prognosis. We first separated the RA patients into two groups: one group with disease progression and one without. The patients with disease progression were predominantly male and had a significantly higher percentage of bone marrow (BM) blasts at the time of diagnosis (3.06 +/- 1.29% vs. 1.44 +/- 1.38%, P < 0.005). This finding was confirmed when the patients were separated into the two groups; those who survived and those who expired (BM blasts: 2.68 +/- 1.59% vs. 1.37 +/- 1.27%, P < 0.005). The survival probabilities were calculated depending on whether or not the RA patients had > or = 3% BM blasts. The RA patients with > or = 3% BM blasts had a significantly worse prognosis (P < 0.01) than the patients with < 3% BM blasts. Notably, the RA patients with > or = 3% BM blasts did not show any significant differences in the incidence of disease progression, mortality rate, or survival probability, when compared with the patients with RA with an excess of blasts (RAEB). The present findings indicate that RA patients are heterogeneous with regard to prognosis, and the RA patients with > or = 3% BM blasts might have a poorer prognosis than those with fewer BM blasts. Thus we propose a general approach in predicting the prognosis of RA patients: those with complex chromosomal changes will expire shortly. Secondly, when the patients do not have any complex changes, the prognosis might be linked to the percentage of BM-blasts at the MDS diagnosis.
我们对难治性贫血（RA）患者的血液学检查结果进行了统计学分析，以确定与预后不良相关的参数。我们首先将RA患者分为两组：一组有疾病进展，另一组无疾病进展。有疾病进展的患者以男性为主，诊断时骨髓（BM）原始细胞百分比显著更高（3.06±1.29%对1.44±1.38%，P<0.005）。当将患者分为存活组和死亡组时，这一发现得到了证实（BM原始细胞：2.68±1.59%对1.37±1.27%，P<0.005）。根据RA患者的BM原始细胞是否≥3%计算生存概率。BM原始细胞≥3%的RA患者预后明显比BM原始细胞<3%的患者差（P<0.01）。值得注意的是，与伴有过多原始细胞的RA（RAEB）患者相比，BM原始细胞≥3%的RA患者在疾病进展发生率、死亡率或生存概率方面没有任何显著差异。目前的研究结果表明，RA患者在预后方面存在异质性，BM原始细胞≥3%的RA患者预后可能比BM原始细胞较少的患者更差。因此，我们提出一种预测RA患者预后的一般方法：有复杂染色体改变的患者将很快死亡。其次，当患者没有任何复杂改变时，预后可能与MDS诊断时BM原始细胞的百分比有关。
