老年急性髓系白血病的不同方案临床疗效及预后分析

摘要

目的 观察老年急性髓系白血病(AML)的临床生物学特点、不同治疗方案的疗效及对生存的影响.方法 回顾性分析北京大学人民医院北京大学血液病研究所2008年2月至2013年2月初诊年龄≥60岁的老年AML,除外急性早幼粒细胞白血病进行化疗的70例患者.根据治疗方法不同,分为去甲基化药物组(9例)、标准化疗组(18例)和小剂量化疗组(43例).比较接受不同诱导方案的3组患者的疗效及预后差异,并对70例患者的生存进行单因素和多因素分析.结果 第一疗程化疗达完全缓解患者33例(47.1％),部分缓解11例(15.7％),不缓解26例(37.1％);死亡8例(11.4％);3例一般状况差未再化疗,进行支持治疗.进入第二疗程化疗患者59例,完全缓解42例,部分缓解3例,不缓解14例,死亡3例.第二疗程缓解率60.0％ (42/70),总缓解率67.1％ (47/70),难治患者14例(20.0％).年龄＞65岁[比值比=2.36,95％置信区间为1.09 ～5.10],不良染色体预后(比值比=2.24,95％置信区间为1.01～4.94),标准方案诱导化疗(比值比=2.48,95％置信区间为1.25 ～ 4.92)是影响生存的主要因素.结论 老年初诊的AML患者应进行危险度分层,采取个体化治疗策略.65岁以下的中低危患者可以选择标准化疗,而65岁以上的高危患者可考虑去甲基化药物治疗.%Objective To explore the biological characteristics and effect of induction chemotherapy(IC) and prognostic analysis in elderly patients with acute myeloid leukemia (AML).Methods The clinical data of 75 AML patients older than 60 years in the institute of hematology,Peking university from February 2008 to February 2013 were analyzed retrospectively.70 patients received chemotherapy,including 18 patients receiving standard protocol such as DA,IA or HAA.43 patients received small dose protocol such as CAG,CHG or MA.The median survival time was compared between the three groups.The prognostic factors were evaluated by univariate and multivariate analysis.Results Thirty-three cases (47.1％) achieved complete remission (CR) ; 11 cases (15.7％) achieved partial remission (PR) ; 26 cases(37.1％) did not relieve and 8 patients died after the first course of chemotherapy.3 patients stopped chemotherapy and received only supportive treatment due to poor condition.Fifty-nine patients continued the second course; the CR,PR,NR and death were 72.9％ (42 cases),5.1％ (3 cases),23.7％ (14 cases) and 5.1％ (3 cases),respectively.The second period of treatment response rate was 60.0％ (42/70) ; the overall CR after 2 courses of chemotherapy was 67.1％ (47/70).The refractory AML occupied 14 patients(20.0％).Multi-factor analysis showed that aged ＞ 65 years [odds ratio (OR)=2.36,95％ confidence interval (CI) 1.09-5.10],bad prognosis of chromosomes (OR =2.24,95％ CI 1.01-4.94)and the standard induction chemotherapy (OR =2.48,95％ CI 1.25-4.92) were the main factors affecting survival.Conclusion Elderly patients with favorable or intermediate risk cytogenetics should be encouraged to receive standard chemotherapy.