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目的探讨成人t(8;21)急性髓系白血病M2型(AML-M2)的生物学特征与疗效和预后的关系。方法采用COX回归模型和Kap lan-M e ier方法对1990年至2003年我所收治的54例初治成人t(8;21)AML-M2患者的预后影响因素进行了回顾性分析。结果160例可统计疗效的AML-M2患者的完全缓解(CR)率为81.9%,其中染色体未见异常组CR率82.4%,t(8;21)异常组CR率88.5%,二者差异无统计学意义(P>0.05)。在52例可统计疗效的t(8;21)患者中,28例单纯t(8;21)患者的CR率为100.0%,24例t(8;21)附加其他染色体异常患者的CR率为75.0%,二者差异有统计学意义(P<0.01)。实际的3年总体生存(OS)率:核型未见异常的AML-M2患者组为20.3%,t(8;21)患者组为25.0%(P>0.05);单纯t(8;21)患者组的3年无病生存(DFS)率为46.4%,有附加染色体异常患者组为0%(P<0.01)。多因素分析显示,是否有附加染色体异常是t(8;21)AML-M2独立的预后因素,对缓解率、DFS及OS均有不良影响。采用异基因造血干细胞移植(HSCT)和中或高剂量阿糖胞苷作为缓解后治疗患者的DFS率明显高于接受常规剂量阿糖胞苷者(P<0.01)。结论t(8;21)AML-M2也存在异质性,有附加染色体异常对预后有不良影响,采用HSCT和中或高剂量阿糖胞苷作为缓解后治疗有利于延长患者生存期。对于有高危险因素的患者,尤其是有附加染色体异常的患者,还是建议进行HSCT。
Objective To investigate the relationship between biological characteristics and efficacy and prognosis of adult acute myeloid leukemia M2 (AML-M2). Methods The prognostic factors of 54 newly diagnosed adults with AML-M2 in our hospital from 1990 to 2003 were retrospectively analyzed by COX regression model and Kaplan-Meier method. Results The complete remission (CR) rate was 81.9% in 160 patients with statistically significant AML-M2, in which the rate of CR was 82.4% in the abnormal group and 88.5% in the abnormal group of t (8; 21), with no difference Statistical significance (P> 0.05). The CR rate of 28 patients with simple t (8; 21) was 100.0% in 52 statistically significant t (8; 21) patients. The CR rate of 24 patients with t (8; 21) other chromosomal abnormalities was 75.0%, the difference was statistically significant (P <0.01). The actual 3-year overall OS rate was 20.3% for the AML-M2 patients with no karyotype and 25.0% for the t (8; 21) patients (P> 0.05) The 3-year disease-free survival (DFS) rate was 46.4% in patients and 0% in patients with additional chromosomal abnormalities (P <0.01). Multivariate analysis showed that additional chromosomal abnormalities were an independent prognostic factor for t (8; 21) AML-M2 with adverse effects on response rates, DFS, and OS. DFS rates were significantly higher in all patients treated with allogeneic hematopoietic stem cell transplantation (HSCT) and with medium or high doses of cytarabine as compared with those receiving conventional doses of cytarabine (P <0.01). CONCLUSION: AML-M2 also has heterogeneity at t (8; 21). Addition of chromosomal aberrations has an adverse effect on prognosis. Using HSCT and medium- or high-dose cytarabine as remission treatment may prolong the survival of patients. For patients with high-risk factors, especially those with additional chromosomal abnormalities, HSCT is recommended.