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目的:分析采用以吡喃阿霉素(pirarubicin,THP)为基础的联合方案治疗急性髓系白血病(acute myeloid leukemia,AML)患者的完全缓解(complete remission,CR)率、无病生存(disease free survival,DFS)以及总生存(overall survival,OS)情况,探讨不同预后因素对于缓解率及其预后的影响。方法:采用以THP为基础的联合方案诱导治疗初治的原发AML患者29例,计算CR率、DFS期、OS期以及1、2年的DFS率和OS率。根据患者年龄、白细胞计数、FAB分型、染色体核型以及免疫表型进行分组,比较各组之间的CR率、总体有效率[部分缓解(partial remission,PR)+CR]和OS期(率)。结果:经1个疗程的TA(THP+阿糖胞苷)方案诱导治疗后,19例(65.5%)患者达到CR,6例(20.7%)患者达到PR,4例(13.8%)患者未缓解(noresponse,NR),总体有效率(PR+CR)为86.2%。19例CR患者的中位DFS期为22.9(4.0~27.0)个月,1、2年的DFS率均为77.1%。患者的中位OS期为18.6(2.0~28.1)个月,1、2年的OS率分别为58.6%和52.8%。年龄<45岁、白细胞计数<20×109/L、FAB分型为M2、染色体核型为良好和中等组、CD9和CD56阴性者的总体有效率(PR+CR)较高。log-rank单因素分析结果显示,年龄<45岁和FAB分型为M2者的OS期较长。结论:采用TA方案诱导治疗AML具有较好的疗效,不良反应较少。患者年龄、白细胞计数、FAB分型、染色体核型以及CD9、CD56的表达是影响治疗有效率的预后相关因素。
OBJECTIVE: To analyze the rate of complete remission (CR) and disease-free survival (CR) in patients with acute myeloid leukemia (AML) treated with pirarubicin (THP) survival, DFS) and overall survival (OS). To explore the effect of different prognostic factors on remission rate and its prognosis. Methods: Thirty-nine patients with primary AML were treated with THP-based regimen. The CR rates, DFS, OS and DFS and OS rates at 1 and 2 years were calculated. According to the age of patients, white blood cell count, FAB typing, karyotype and immunophenotype, the CR rate, total remission (PR) + CR, and OS rate ). RESULTS: After a course of TA (THP + cytarabine) regimen induction, 19 (65.5%) patients achieved CR, 6 (20.7%) achieved PR, and 4 (13.8% noresponse, NR), the overall response rate (PR + CR) was 86.2%. The median DFS of 19 CR patients was 22.9 (4.0-27.0) months, and the DFS rates at 1 and 2 years were 77.1%. The median OS was 18.6 (2.0-28.1) months. The OS rates at 1 and 2 years were 58.6% and 52.8%, respectively. Age <45 years, white blood cell count <20 × 109 / L, FAB genotype M2, good and medium karyotype karyotype, and high total effective rate (PR + CR) in CD9 and CD56 negative. The results of log-rank univariate analysis showed that patients aged <45 years and those with FAB genotype M2 had longer OS. Conclusion: The induction of AML with TA regimen has better curative effect and fewer side effects. The patient’s age, white blood cell count, FAB typing, chromosome karyotype, and the expression of CD9 and CD56 are the prognostic factors influencing the treatment efficiency.