急性早幼粒细胞白血病170例长期生存分析.docx

急性早幼粒细胞白血病170例长期生存分析【摘要】本研究探讨影响急性早幼粒细胞白血病患者长期生存的预后因素。在回顾性分析了1990年1月至2004年12月本院170例APL患者的临床资料后，应用Log-Rank检验和Cox回归模型对170例患者的性别、年龄、初诊时白细胞计数、血清乳酸脱氢酶水平、诱导缓解方案、获得缓解时间、缓解后治疗方案、PML/RARα阳性率进行单因素和多因素综合分析。结果表明：170例患者中位随访36个月，5年预计总体生存率为%，5年预计无复发生存率为%。23例患者于中位缓解后15个月复发。单因素分析显示，初诊时WBC计数、诱导缓解方案、获得缓解时间、缓解后治疗方案、PML/RARα阳性率均为影响APL患者长期生存的主要因素；多因素分析显示，缓解后治疗方案是影响APL患者长期生存的重要的独立因素。结论：在APL患者获得完全缓解后，应用化疗+维甲酸+砷剂的缓解后治疗方案将显着延长患者的生存时间。【关键词】急性早幼粒细胞白血病Long-TermSurvivalAnalysisin170CasesofAcutePromyelocyticLeukemiaAbstractThisstudywasaimedtoinvestigatevariousfactorsinfluencinglong-termsurvivalinpatientswithacutepromyelocyticleukemia.Asingleinstitutionalretrospectivestudywithlong-termfollow-upwasperfomedtobetterdefinetheprognosticfactorsandarationalefortheuseofATRA，chemotherapy，andAs2O3inthetreatmentofnewlydiagnosedAPLpatients.NewlydiagnosedpatientswithAPLenteringcompleteremission(CR)werefollowedupfor6to185months(n=170)fromJanuary1990toDecember2004.Univariateandmultivariateanalysisof8potentialfactorsinfluencingsurvivalandprognosiswerecarriedoutwithLog-RankandCoxregressionmethod，includingsex，age，initialWBCcount，theleveloflactichydrogenase(LDH)，firstinductionregimen，timefrominductiontherapytoCR，post-remissiontherapy，negativeorpositiverateofPML-RARalphaandfollow-upofreversetranscription-polymerasechainreaction(RT-PCR).Theresultsshowedthattheestimated5-yearoverallsurvival(OS)andrelapse-freesurvival(RFS)were%±%and%±%respectively.The23patientsrelapsedatthemediantimeof15monthsafterCR.UnivariateanalysisrevealedthatinitialWBCcount，firstinductionregimen，timefrominductiontherapytoCR，typeofpost-remissiontherapyandpersistentnegativeRT-PCRinremissionwereimportantprognosticfactorsforlong-termsurvival.Multivariatestudydemonstratedthatonlytypeofpost-remissiontherapywasassociatedwithRFSandOS.Iti