>
网站首页期刊介绍通知公告编 委 会投稿须知电子期刊广告合作联系我们
最新消息:
具有合并症的急性髓系白血病老年患者的临床特征及预后分析
作者:陈月1 2  陶善东1 2  史玉叶1 2  宋立孝1 2  邓媛1 2  凌兰兰1 2  丁邦和1 2  陈侃侃1 2  何正梅1 2  王春玲1 2  于亮1 2 
单位:1. 南京医科大学附属淮安第一医院 血液科, 江苏 淮安 223300;
2. 南京医科大学 血液病重点实验室, 江苏 南京 210029
关键词:急性髓系白血病 合并症 细胞因子 染色体核型 老年人 
分类号:R733.7
出版年·卷·期(页码):2019·38·第四期(618-623)
摘要:

目的:探讨具有合并症的急性髓系白血病(acute myeloid leukemia,AML)老年患者的临床特征及预后。方法:回顾性分析55例初诊≥60岁具有合并症的AML患者的临床特征、治疗经过,比较减量MAG或CAG、标准剂量DA或IA、地西他滨联合半程CAG等3种不同诱导治疗方案的CD34、CD38表达,正常核型和异常核型患者的疗效、生存时间。结果:(1)化疗较姑息治疗能够显著延长患者生存时间;(2)减量MAG或CAG、标准剂量DA或IA、地西他滨联合半程CAG等3种诱导方案在总体反应率上无明显差异;(3)CD34、CD38表达,基因阳性以及染色体核型在老年患者的总生存时间上无明显差异;(4)控制良好的高血压、糖尿病等合并症对患者的生存时间无明显影响,合并肺部感染患者的总生存时间明显缩短。结论:化疗能够改善具有合并症的AML老年患者预后,合并肺部感染的老年患者预后较差,CD34与CD38表达、遗传学异常对具有合并症的AML老年患者的总生存时间影响不显著。

Objective: To investigate the survival and prognosis of acute myeloid leukemia (AML) in elderly patients with complications. Methods: The clinical characteristics and treatments of 55 newly diagnosed AML patients with complications at the age of ≥ 60 were analyzed retrospectively, to compare the efficacy and survival of three different induction regimens, including low-dose of MAG or CAG, standard-dose of DA or IA, and decitabine plus half-dose of CAG, and to compare the efficacy and expressions of CD34 and CD38, normal karyotype and abnormal karyotype. Results: (1) The survival time of the patients was prolonged significantly by chemotherapy than by palliative treatment. (2) There was no significant difference in the overall response rate among the three induction schemes of MAG or CAG, standard dose DA and decitabine plus half-dose of CAG. (3) There was no significant difference between the expression of CD34 and CD38, gene positive and chromosome karyotype in the overall survival of elderly patients. (4) Well-controlled complications such as hypertension, diabetes and so on had no obvious effect on the survival of the patients, but the total survival of the elderly patients with pulmonary infection decreased. Conclusion: Chemotherapy can improve the prognosis of elderly AML patients with senile complications, and the prognosis of these patients with pulmonary infection was poor. The expression of CD34 and CD38, and the genetic abnormalities have no significant effect on the overall survival of elderly AML patients with senile complications.

参考文献:

[1] LIM S H,DUBIELECKA P M,RAGHUNATHAN V M.Molecular targeting in acute myeloid leukemia[J].J Transl Med,2017,15(1):183.
[2] BELL J A,GALAZNIK A,HUELIN R,et al.Effectiveness and safety of therapeutic regimens for elderly patients with acute myeloid leukemia:a systematic literature review[J].Clin Lymphoma Myeloma Leuk,2018,18(7):e303-e314.
[3] LAURA F,ANDREW D,JAMES F,et al.Older patients with acute myeloid leukemia:treatment challenges and future directions[J].Ochsner J,2017,17(4):398-404.
[4] McCURDY S R,LEVIS M J.Emerging molecular predictive and prognostic factors in acute myeloid leukemia[J].Leuk Lymphoma,2018,59(9):2021-2039.
[5] 赵慧慧,黄佳瑜,朱雨,等.CD56阳性老年急性髓系白血病患者的临床特征及预后分析[J].老年医学与保健,2017,23(6):492-495.
[6] SEKERES M A,ELSON P,KALAYCIO M E,et al.Time from diagnosis to treatment initiation predicts survival in younger,but not older,acute myeloid leukemia patients[J].Blood,2009,113(1):28-36.
[7] BERTOLI S,BERARD E,HUGUET F,et al.Time from diagnosis to intensive chemotherapy initiation does not adversely impact the outcome of patients with acute myeloid leukemia[J].Blood,2013,121(14):2618-2626.
[8] HERVE D,RAPHAEL I.How and when to decide between epigenetic therapy and chemotherapy in patients with AML[J].Hematology Am Soc Hematol Educ Program,2017,2017(1):45-53.
[9] LEY T J,DING L,WALTER M J,et al.DNMT3A mutations in acute myeloid leukemia[J].N Engl J Med,2010,363(25):2424-2433.
[10] DING L,LEY T J,LARSON D E,et al.Clonal evolution in relapsed acute myeloid leukaemia revealed by whole-genome sequencing[J].Nature,2012,481(7382):506-510.
[11] SHLUSH L I,MITCHELL A,HEISLER L,et al.Tracing the origins of relapse in acute myeloid leukaemia to stem cells[J].Nature,2017,547(7661):104-108.
[12] PAPAEMMANUIL E,GERSTUNG M,BULLINGER L,et al.Genomic classification and prognosis in acute myeloid leukemia[J].N Engl J Med,2016,374(23):2209-2221.

服务与反馈:
文章下载】【发表评论】【查看评论】【加入收藏
提示:您还未登录,请登录!点此登录
您是第 180376 位访问者


copyright ©《东南大学学报(医学版)》编辑部
联系电话:025-87232481 83272483
电子邮件:
bjb@pub.seu.edu.cn

苏ICP备09058364