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目的:分析急性单核细胞白血病的临床、生物学特征和生存、预后。方法:对183例患者的临床资料进行总结,了解一般情况、免疫分型、染色体核型、治疗、生存等情况。结果:①158例患者行诱导化疗,完全缓解(CR)率74.1%,初次诱导应用mHAD者CR率(86.2%),明显高于其他方案诱导者(62.8%);②161例行染色体核型分析,正常核型占55.9%;未见分裂象6例;异常核型40.4%,涉及11q(23)、+8、9q/del(9q)、复杂核型等,核型正常者CR率明显高于核型异常者,预后中等组患者CR率,1年、3年OS及DFS率明显好于预后差组,但与意义未知组患者无明显差别。③CR的患者采用含ID-Ara-C诱导及巩固治疗组,1年、3年OS及DFS率明显优于标准剂量Ara-C诱导及巩固治疗组。巩固治疗≥2疗程者明显优于巩固治疗1疗程者。④COX多因素分析显示,染色体核型、CD11b的表达、巩固治疗疗程数对生存有显著的影响。结论:M5核型以预后差者多见,含中剂量Ara-C的诱导及巩固治疗组治疗可提高生存率,染色体核型、CD11b表达及巩固治疗的疗程数明显影响患者的生存。
Objective: To analyze the clinical, biological characteristics and survival and prognosis of acute monocytic leukemia. Methods: The clinical data of 183 patients were summarized to understand the general situation, immunophenotyping, chromosome karyotype, treatment, survival and so on. Results: ① In 158 patients, the complete remission (CR) rate was 74.1%. The CR rate (86.2%) in the first induction of mHAD was significantly higher than that in the other regimens (62.8%). ② The karyotype analysis of 161 patients, Normal karyotype accounted for 55.9%; no schizoid in 6 cases; abnormal karyotype 40.4%, involving 11q (23), +8,9 q / del (9q), complex karyotype, normal karyotype CR rate was significantly higher The karyotype of patients with moderate prognosis, CR rate, 1-year, 3-year OS and DFS rate was significantly better than the poor prognosis group, but with no significant difference between the unknown group of patients. ③CR patients with ID-Ara-C induction and consolidation treatment group, 1 year, 3-year OS and DFS rate was significantly better than the standard dose Ara-C induction and consolidation treatment group. Consolidation therapy ≥ 2 courses were significantly better than the consolidation treatment of a course of treatment. ④ COX multivariate analysis showed that the expression of chromosome karyotype, CD11b and the number of consolidation treatment have significant effects on survival. Conclusion: M5 karyotype is more common in patients with poor prognosis. Treatment with medium-dose Ara-C and consolidation therapy can improve the survival rate. The number of chromosome karyotype, CD11b expression and consolidation treatment significantly affect the survival of patients.