论文部分内容阅读
目的评价初治儿童急性髓系白血病(AML)的疗效及探讨除急性早幼粒细胞白血病(APL)外的 AML 的预后相关因素。方法 141例18岁以下 AML 患者分成 APL 组(A 组,51例)和除APL 外的 AML 组(B 组,90例)进行回顾性研究分析。采用 Kaplan-Meier 曲线评估患者的无事件生存(EFS)率、无病生存(DFS)率和总生存(OS)率,Cox 回归模型评估预后因素。结果 B 组1个疗程完全缓解(CR)率为54.4%(49例),总缓解率为76.7%。5年累积 EFS 率、DFS 率和 OS 率分别为(28.4±9.0)%、(28.39±8.96)%和(35.5±6.3)%;A 组5年累积 EFS 率、DFS 率和 OS 率分别为(81.5±5.7)%、(94.3±4.0)%和(81.4±5.7)%:全部141例 AML 患儿5年累积 DFS 率和5年累积OS 率分别为(56.9±6.3)%和(53.3±4.8)%。B 组病例经多因素分析表明,初诊时骨髓白血病细胞比例较高和≥2个疗程达 CR 以及巩固治疗6个疗程以下是影响患者预后的危险因素(P 值均<0.05)。结论儿童 APL 预后良好。其他儿童 AML 中,初诊时骨髓原始细胞比例低和1个疗程达CR 以及巩固治疗6个疗程以上者预后较优;儿童 M_(2h)/t(8;21)与除 APL 以外的其他亚型相比没有显示预后良好的趋势;降低复发是改善儿童 AML 预后的关键。
Objective To evaluate the curative effect of children with acute myeloid leukemia (AML) and explore the prognostic factors of AML except acute promyelocytic leukemia (APL). Methods A total of 141 AML patients under 18 years old were divided into three groups: APL group (51 cases) and AML group (90 cases) except APL. Patients were assessed for Kaplan-Meier curve for event-free survival (EFS), disease-free survival (DFS), and overall survival (OS) rates, and Cox regression models were used to assess prognostic factors. Results One course of complete remission (CR) rate was 54.4% (49 cases) in group B, with a total response rate of 76.7%. The 5-year cumulative EFS, DFS and OS rates were (28.4 ± 9.0)% and (28.39 ± 8.96)% and (35.5 ± 6.3)%, respectively. The 5-year cumulative EFS, DFS and OS rates in group A were 81.5 ± 5.7%, 94.3 ± 4.0% and 81.4 ± 5.7%, respectively. The 5-year cumulative DFS and 5-year cumulative OS of all 141 AML children were (56.9 ± 6.3)% and (53.3 ± 4.8)%, respectively )%. Group B patients by multivariate analysis showed that newly diagnosed patients with higher proportion of bone marrow leukemia cells and ≥ 2 courses of CR and consolidation treatment of 6 courses are the risk factors affecting the prognosis of patients (P all <0.05). Conclusion The prognosis of children with APL is good. In other children, the initial prognosis of bone marrow cells in low proportion and a course of up to CR and consolidation of more than 6 courses of treatment is better prognosis; children M 2h / t (8; 21) with the exception of other than subtype of APL Compared with no good prognosis trend; reduce relapse is to improve the prognosis of children with AML.