HCT-CI评分指导老年性急性髓系白血病治疗选择

摘要

Objective:To explore the feasibility of guiding the individalized treatment strategy for elderly AML patients by using hematopoietic cell transplantation-comorbidity index (HCT-CI) score.Methods:The clinical and biological data of 165 elderly (260 years) AML patients in department of hematology of the first affiliated hospital of Wenzhou medical universtity from January 2000 to December 2014 were analyzed retrospectively.The AML patients were divided into 3 groups:score 0-1,2-3 and ≥4 according to HCT-CI,then the patients in each group again were divided into standard chemotherapy group,low dose chemotherapy group and support therapy group accoriding to therapeutic regimens,and the efficacy of above mentioned 3 kinds of treatment and their effects on survival of ealderly AML patients were compared,the prognostic risk factors for patients were analyzed further.Results:A total of 165 patients (100％) were followed-up,and the mean follow-up time was 309 days,median survival time was 210 days.The survival analysis showed that the patients in HCT-CI score 0-1 group and 2-3 group banefited from chemotherapy,while the survival analysis of the HCT-CI score ≥ 4 group showed that there were no significant differance in survival rate between support therapy and chemotherapy groups.The complete remission rate and early mortality of patients received low dose or standard dose chemotherapy in HCT-CI score 0-1,2-3 and ≥ 4 groups were not significantly different.Univariate analysis and multivariante analysis of COX ratio risk model showed that the EOCG-PS ≥ 2,WBC ≥ 100 × 107/L at initial diagnosis and HCT-CI score ≥ 4 were the independent risk factor affecting the prognosis of elderly AML patients.The median survival time of patients received chemotherapy and support therapy was 840 and 150 d(P ＜ 0.01) in HCT-CI score 0-1 group respectively,210 and 60 days (P ＜ 0.01) in HCT -CI score 2-3 group respectively,130 and 90 days (P ＞ 0.05) in HCT-CI score ≥ 4 group,respectively.Conclusion:The HCT-CI score can be used as simple and feasible evaluation criteria to judge the selection of individualized treatment strategy for elderly AML patients.%目的:探讨造血干细胞移植合并症评分(HCT-CI)用于指导老年急性髓系白血病(AML)个体化治疗策略的可行性.方法:本研究回顾性分析温州医科大学附属第一医院血液科2000年1月至2014年12月收治的165例初诊老年AML患者的临床及生物学资料,将患者根据HCT-CI评分分为0-1、2-3和≥4分组;每组按照治疗方案再分为标准化疗、小剂量化疗组和支持治疗组,比较3种不同治疗方案对患者的疗效及生存的影响,进一步对患者多种预后危险因素进行分析.结果:对165例患者进行了随访,平均随访期为309 d,中位生存期为210 d.单因素及COX比例风险模型多因素分析显示,EOCG-PS≥2、初诊时WBC≥100×109/L、HCT-CI评分≥4均是影响老年AML患者预后的独立危险因素.HCT-CI评分为0-1分组,选择化疗和支持治疗者中位生存期分别为840和150 d(P＜0.01),2-3分组分别为270和60d(P＜0.01),≥4分组分别为130和90 d(P ＞0.05).HCT-CI≤3分的患者得益于化疗,而HCT-CI≥4分的患者相比化疗而言,则更得益于支持治疗.结论:HCT-CI评分可以作为指导老年AML个体化治疗策略选择的简单可行的评估标准.