【摘要】 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。更多还原

【Abstract】 Objective To investigate the relationship between the biological features and the treatment efficacy and prognosis in acute myeloid leukemia subtype M₂ （AML-M₂） patients with chromosome 8 and 21 translocation. Methods By using Cox regression model and Kaplan-Meier analyses, prognostic factors in 54 cases of de novo adult AML with t（8;21） in our institute from 1990 to 2003 were retrospectively analyzed. Result The complete remission （CR） rates were 81.9% for all M₂ patients, 82.4% for patients with normal karyotype, 88.5% for patients with t（8;21） -P>0.05 for normal karyotype vs t（8;21）-, 100.0% for 28 patients with t（8;21） alone and 75.0% for 24 patients with additional chromosome abnormalities （[WTBX]P<（0.01））. The actuarial 3 year overall survival（OS） was 26% for M₂ patients with normal karyotype, 25% for patients with t（8;21） -P[WTBZ]>0.05 for normal karyotype vs t（8;21）-, in whole t（8;21） group, 46.4% for patients with t（8;21） alone and 0% for patients with additional chromosome abnormalities （P<0.01）. Multivariate analysis of prognostic factors showed that chromsome abnormalities besides t（8;21） was the only factor affecting CR, disease-free survival（DFS） and OS. DFS of allogeneic hematopoietic stem cell transplantation（HSCT） and intermediate-dose cytarabine/high dose cytarabine（IDAC） groups were better than the group received routine dose cytarabine as postremission therapy（P<0.01）. Conclusion AML with t（8;21） is not a single defined AML subset, and patients with additional chromosome abnormalities have a worse prognosis. HSCT and IDAC could improve the outcome. HSCT is the best choice for patients with high risks, especially with additional chromsome abnormalities.更多还原