163例急性早幼粒细胞白血病患者随访结果分析

doi:10.3969/j.issn.1004-583X.2023.09.007

摘要/Abstract

摘要：

目的探讨急性早幼粒细胞白血病(Acute promyelocytic leukemia, APL)患者预后因素。方法回顾性分析2010年1月至2022年12月在安徽医科大学第二附属医院确诊的163例初诊的APL患者资料,包括人口统计学、临床血液学特征、治疗、毒性、并发症和预后。结果患者中位年龄为35(2~84)岁,早期死亡(Early death, ED)13例(8.0%),148例(90.8%)达到了完全缓解,存在附加染色体核型 (Additional chromosomal abnormalities, ACA) 23例(14.1%),FLT3-ITD突变19例(11.7%),低、中和高危组分别有38例(23.3%)、74例(45.4%)和51例(31.3%),联合化疗患者78例(47.9%),其中高危患者29例,低中危患者49例。ED患者的年龄高于非ED组( $P$ <0.01);高危组ED比例显著增加( $P$ =0.001)。中位随访时间为42.5(0.1~156)月,5年无进展生存(progression-free survival, PFS)为73.3%,5年总生存(overall survival, OS)为79.5%,中位PFS及OS均未达到。在单因素分析中,年龄和治疗方案对PFS(分别为 $P$ <0.01, $P$ =0.053)和OS(分别为 $P$ <0.01, $P$ =0.021)产生影响。多因素分析仅年龄有较差的PFS( $P$ <0.01)和OS( $P$ <0.01)。而治疗方案对PFS( $P$ =0.213)和OS( $P$ =0.097)无影响。结论年龄和高危是导致APL患者ED的影响因素;年龄是APL患者PFS和OS的独立预后因素;高危患者减少化疗被证明是可行的。

关键词: 白血病, 早幼粒细胞, 急性, 早期死亡, 年龄, 化疗

Abstract:

Objective To explore the prognosis factors for patients with acute promyelocytic leukemia (APL). Methods Clinical data of 163 newly diagnosed APL patients in the Second Hospital of Anhui Medical University from January 2010 to December 2022 were retrospectively analyzed, including demographic data, hematological characteristics, treatment course, toxicity, complications, and prognosis. Results The median age of recruited patients was 35 (2-84) years. There were 13 (8.0%) cases of early death (ED), and 90.8% achieved a complete remission. There were 23 (14.1%) cases of additional chromosomal abnormalities (ACA) and 19 (11.7%) cases of FLT3-ITD mutation. Among them, 38 (23.3%), 74 (45.4%) and 51 (31.3%) were classified as low risk, intermediate risk, and high risk, respectively. A total of 78 (47.9%) cases were managed by a combination chemotherapy, including 29 cases in the high-risk group and 49 cases in the low-to-intermediate-risk group. The age of ED patients was significantly higher than that of non-ED group ( $P$ <0.01), and the proportion of ED in the high-risk group was significantly higher than that of other groups ( $P$ =0.001). The median follow-up time was 42.5 (0.1-156) months, with the 5-year progression-free survival (PFS) and 5-year overall survival (OS) of 73.3% and 79.5%, respectively, both of which did not reach the median PFS and OS. The univariate logistic regression analysis showed that age and treatment regimen significantly influenced PFS ( $P$ <0.01, and $P$ =0.053, respectively) and OS ( $P$ <0.01, and $P$ =0.021, respectively). Multivariate logistic regression analysis showed that age was the only risk factor for the PFS ( $P$ <0.01) and OS of APL ( $P$ <0.01). Treatment regimen was identified without a significant influence on the PFS ( $P$ =0.213) and OS ( $P$ =0.097). Conclusion Age and the classification of high risk are influencing factors for ED in APL patients. Age is an independent prognostic factor for the PFS and OS of APL. Reducing the chemotherapy cycles is proven feasible in high-risk APL patients.

Key words: acute promyelocytic leukemia, early death, age, chemotherapy

中图分类号:

R733.71

董整荣, 陶千山, 沈元元, 董毅. 163例急性早幼粒细胞白血病患者随访结果分析[J]. 临床荟萃, 2023, 38(9): 813-818.

Dong Zhengrong, Tao Qianshan, Shen Yuanyuan, Dong Yi. Analysis of the follow-up results of 163 patients with acute promyelocytic leukemia[J]. Clinical Focus, 2023, 38(9): 813-818.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2023.09.007

https://huicui.hebmu.edu.cn/CN/Y2023/V38/I9/813

图/表 5

表1 患者临床特征

Tab. 1 Clinical characteristics of the patients

临床特征	数值
年龄(岁)	35(2~84)
性别[例(%)]
男	75(46.0)
女	88(54.0)
风险分层[例(%)]
低危	38(23.3)
中危	74(45.4)
高危	51(31.3)
早期死亡[例(%)]	14(8.6)
FLT3突变[例(%)]
有	19(11.7)
无	144(88.3)
ACA[例(%)]
有	23(14.1)
无	140(85.9)
联合化疗[例(%)]
是	78(47.9)
否	85(52.1)

表2 早期死亡患者的临床特征

Tab. 2 Clinical characteristics of early death patients

因素	早期死亡( $n$ =13)	非早期死亡( $n$ =150)	$P$ 值	统计值
年龄(岁)	61(27~84)	33(2~80)	<0.01	30.856
性别[例(%)]
男女	4(30.8) 9(69.2)	71(47.3) 79(52.7)	0.250	1.321
血红蛋白(g/L)	75(35~117)	80(32~143)	0.857	0.181
WBC(×10⁹/L)	21(0.53~116.94)	2.9(0.23~122)	0.004	2.855
PLT(×10⁹/L)	15(5~41)	20.5(1~134)	0.192	1.305
纤维蛋白(mg/dl)	0.85(0.52~5.68)	1.23(0.20~5.47)	0.128	1.522
PT(s)	15.9(11.4~30.8)	13.15(9.6~19.8)	0.086	1.719
APTT(s)	28.2(22.1~57.6)	27.85(16.5~48)	0.360	0.916
危险分层[例(%)]
低危	0(0)	38(25.3)
中危	3(23.1)	71(47.3)	0.001	14.246
高危	10(76.9)	41(27.3)
ACA[例(%)]
有无	0(0) 13(100)	23(14.1) 127(85.9)	0.268	1.228
FLT3突变[例(%)]
有无	2(15.4) 11(84.6)	17(11.3) 133(88.7)	0.663	0.435

表2 早期死亡患者的临床特征

Tab. 2 Clinical characteristics of early death patients

因素	早期死亡( $n$ =13)	非早期死亡( $n$ =150)	$P$ 值	统计值
年龄(岁)	61(27~84)	33(2~80)	<0.01	30.856
性别[例(%)]
男女	4(30.8) 9(69.2)	71(47.3) 79(52.7)	0.250	1.321
血红蛋白(g/L)	75(35~117)	80(32~143)	0.857	0.181
WBC(×10⁹/L)	21(0.53~116.94)	2.9(0.23~122)	0.004	2.855
PLT(×10⁹/L)	15(5~41)	20.5(1~134)	0.192	1.305
纤维蛋白(mg/dl)	0.85(0.52~5.68)	1.23(0.20~5.47)	0.128	1.522
PT(s)	15.9(11.4~30.8)	13.15(9.6~19.8)	0.086	1.719
APTT(s)	28.2(22.1~57.6)	27.85(16.5~48)	0.360	0.916
危险分层[例(%)]
低危	0(0)	38(25.3)
中危	3(23.1)	71(47.3)	0.001	14.246
高危	10(76.9)	41(27.3)
ACA[例(%)]
有无	0(0) 13(100)	23(14.1) 127(85.9)	0.268	1.228
FLT3突变[例(%)]
有无	2(15.4) 11(84.6)	17(11.3) 133(88.7)	0.663	0.435

图1 患者无进展生存

Fig. 1 Progression-free survival of patients

图2 患者总生存

Fig. 2 Overall survival of patients

表3 影响APL患者 PFS及OS单因素分析

Tab. 3 Univariable analysis of PFS and OS in APL patients

因素	例(%)	PFS		OS
因素	例(%)	χ²值	$P$ 值	χ²值	$P$ 值
年龄
≤60岁 >60岁	149(91.4) 14(8.6)	28.289	<0.01	29.296	<0.01
性别
男女	75(46.0) 88(54.0)	0.001	0.972	0.002	0.962
ACA
有无	23(14.1) 140(85.9)	0.194	0.659	0.258	0.611
FLT3突变
有无	19(11.7) 144(88.3)	0.587	0.444	0.392	0.531
危险分层
低危	38(23.3)
中危	74(45.4)	2.554	0.279	2.655	0.265
高危	51(31.3)
治疗方案
不联合化疗联合化疗	85(52.1) 78(47.9)	3.738	0.053	5.355	0.021

表3 影响APL患者 PFS及OS单因素分析

Tab. 3 Univariable analysis of PFS and OS in APL patients

因素	例(%)	PFS		OS
因素	例(%)	χ²值	$P$ 值	χ²值	$P$ 值
年龄
≤60岁 >60岁	149(91.4) 14(8.6)	28.289	<0.01	29.296	<0.01
性别
男女	75(46.0) 88(54.0)	0.001	0.972	0.002	0.962
ACA
有无	23(14.1) 140(85.9)	0.194	0.659	0.258	0.611
FLT3突变
有无	19(11.7) 144(88.3)	0.587	0.444	0.392	0.531
危险分层
低危	38(23.3)
中危	74(45.4)	2.554	0.279	2.655	0.265
高危	51(31.3)
治疗方案
不联合化疗联合化疗	85(52.1) 78(47.9)	3.738	0.053	5.355	0.021

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