摘要
目的:探讨急性早幼粒细胞白血病(APL)患者早期死亡、生存及其复发的影响因素。方法:对2002年1月至2016年5月我院MDS诊疗中心收治的176例APL患者的临床及实验室特征进行回顾性分析,分析患者早期死亡的危险因素以及影响总生存(OS)、无复发生存(RFS)的因素。结果:176例APL患者中早期死亡患者10例。多因素分析显示,年龄≥60岁(HR=6.4,95%CI 1.4-28.2,P=0.015)和纤维蛋白原<1.5 g/L(HR=12.2,95%CI 1.5-102.8,P=0.021)是APL患者早期死亡的独立危险因素。对有完整长期随访资料的154例患者进行随访,中位随访时间101(2-262)个月,5年预计总生存率及无复发生存率分别为(98±1)%和(77±4)%。治疗过程中出现复发(HR=13.9,95%CI 1.6-119.5)(P=0.016)及初诊时WBC≥30×10~9/L(HR=6.0,95%CI 1.1-33.3)(P=0.039)是APL患者OS独立不良预后因素。合并银屑病是APL患者复发的独立危险因素(HR=4.8,95%CI 1.8-12.5)(P=0.002),而危险度分组为低危组是复发的独立保护因素(HR=0.4,95%CI 0.2-0.99)(P=0.048)。结论:对老年和低纤维蛋白原患者需重视其早期死亡风险,对合并银屑病及非低危组患者加强动态监测有助于及早发现复发,对复发和WBC≥30×10~9/L的患者选择更优化的治疗策略,有可能使患者获得更好的预后。
Objective： To investigate the factors affecting the early-death,overall survival（ OS） and relapse-free survival（ RFS） of acute promyelocytic leukemia（ APL） patients. Methods： The clinical and laboratorial charachteristics of 176 APL patients in our center were analyzed retrospectively during January 2002 to Mar 2016. The risk factors of early death and factors affecting OS and RFS of patients were analyzed. Results： Among total of 176 patients,early death occured in 10 patients. Multivariate analysis showed both age ≥60 years and fibrinogen 1. 5 g/L（ HR = 6. 4,95% CI 1. 4-28. 2）（ P = 0. 015）,（ HR = 12. 2,95% CI 1. 5-102. 8）（ P = 0. 021）,respectively were the independent risk factors for the early death during the induction therapy. Among 154 patients with full follow-up data（ median follow-up time was 101（ 2-262） months）,the estimated 5-year OS and RFS rate were（ 98 ± 1） % and（ 77 ±4） %,respectively. Cox regression analysis showed relapse during treatment as well as initial WBC count≥30 × 10^9/L were independent prognostic indicators for OS. Accompanied psoriasis indicated higher relapse rate of APL（ HR = 4. 8,95% CI 1. 8-12. 5）（ P = 0. 002）,while the low-risk APL indicated lower relapse rate（ HR = 0. 4,95% CI 0. 2-0. 99）（ P = 0. 048）. Conclusion： Importance should be attached to the early-death events in elder and low-fibrinogen APL patients. As for patients with psoriasis or non low-risk group,emphasizing the intensified dynamic supervision during the treatment helps to detect the early-relapse events. For relapsed patients and patients with ≥30 × 10^9/L WBC count,seeking more optimized therapy strategy seems allowthis cohorts to get better prognosis.
出处
《中国实验血液学杂志》
CAS
CSCD
北大核心
2018年第1期52-57,共6页
Journal of Experimental Hematology
基金
卫生公益性行业科研专项经费项目(201202017)
关键词
急性早幼粒细胞白血病
早期死亡
总生存
无复发生存
银屑病
acute promyelocytic leukemia
early-death event
overall survival
relapse free survival
psoriasis
