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目的:探讨外周血淋巴细胞绝对计数(ALC)与IA方案即标准剂量的去甲氧柔红霉素(IDA)联合阿糖胞苷(Ara-C)诱导治疗初治急性髓系白血病(AML)(除外急性早幼粒细胞白血病)患者预后的关系。方法:155例初治AML患者均接受IA方案诱导治疗:IDA 10~12mg/(m~2·d),第1~3天,Ara-C 100mg/(m~2·d),持续静脉滴注第1~7天。126例IA诱导治疗达完全缓解(CR)患者的后继治疗包括:70例采用以大剂量Ara-C为主的化疗;32例行自体干细胞移植(auto-HSCT);24例行异基因造血干细胞移植(allo-HSCT)。回顾性分析诱导治疗后第10天ALC(ALC-10)、第14天ALC(ALC-14)与总生存时间(OS)、无复发生存时间(RFS)的关系。结果:首次诱导治疗后,5例(3.2%)发生早期死亡,其余150例进行疗效评估,其中126例(84.0%)达到CR,9例(6.0%)获得部分缓解。ALC-10≥0.435×10~9/L者与ALC-10<0.435×10~9/L者中位OS分别为13.6个月、18.5个月(P=0.019),前者中位RFS优于后者(13.6个月∶10.0个月,P=0.007);ALC-14≥0.270×10~9/L者与ALC-14<0.270×10~9/L者中位OS分别为14.8个月、17.0个月(P=0.002),前者中位RFS优于后者(11.8个月∶10.0个月,P=0.002)。多因素分析显示,ALC-14是影响RFS的独立危险因素。在以大剂量Ara-C为主的化疗组和auto-HSCT组,ALC-14≥0.270×10~9/L者与ALC-14<0.270×10~9/L者相比,RFS均明显延长(P=0.025、0.028)。在allo-HSCT组,ALC-14对RFS的影响无统计学意义。结论:ALC-14可以作为判断IA方案诱导治疗初治AML患者预后的指标,尤其是CR后接受以大剂量Ara-C为主的化疗和auto-HSCT患者。
Objective: To investigate the relationship between absolute lymphocyte count (ALC) in peripheral blood lymphocytes and acute lymphoblastic leukemia (AML) induced by IA regimen (standard dose of daunorubicin combined with Ara-C) (Except acute promyelocytic leukemia) prognosis of patients. Methods: A total of 155 patients with newly diagnosed AML were treated with induction therapy of IA regimen: IDA 10 ~ 12mg / (m ~ 2 · d), days 1 ~ 3 and Ara-C 100mg / (m ~ 2 · d) Note 1 to 7 days. Follow-up treatment of 126 patients with complete remission (CR) induced by IA included 70 patients receiving high-dose Ara-C chemotherapy, 32 patients receiving auto-HSCT, 24 patients with allogeneic hematopoietic stem cells Transplantation (allo-HSCT). The relationship between ALC (ALC-10), 14th day ALC (ALC-14), total survival time (OS), and recurrence-free survival time (RFS) was analyzed retrospectively on the 10th day after induction therapy. Results: After the first induction therapy, 5 cases (3.2%) died early and the remaining 150 cases were evaluated. 126 cases (84.0%) achieved CR, and 9 cases (6.0%) achieved partial remission. The median OS of ALC-10≥0.435 × 10 ~ 9 / L and ALC-10 <0.435 × 10 ~ 9 / L were 13.6 months and 18.5 months respectively (P = 0.019) (13.6 months: 10.0 months, P = 0.007). The median OS of ALC-14≥0.270 × 10 ~ 9 / L and ALC-14 <0.270 × 10 ~ 9 / L were 14.8 months and 17.0 Months (P = 0.002), the former was superior to the latter in the median RFS (11.8 months: 10.0 months, P = 0.002). Multivariate analysis showed that ALC-14 was an independent risk factor for RFS. In the group of high dose Ara-C-based chemotherapy and auto-HSCT, RFS were significantly prolonged in patients with ALC-14≥0.270 × 10 ~ 9 / L and those with ALC-14 <0.270 × 10 ~ 9 / L (P = 0.025,0.028). In the allo-HSCT group, ALC-14 had no significant effect on RFS. Conclusion: ALC-14 can be used as an index to judge the prognosis of newly diagnosed AML patients induced by IA regimen, especially after high dose Ara-C chemotherapy and auto-HSCT.