论文部分内容阅读
目的:探讨高白细胞急性髓系白血病(HAML)患者的临床特征、预后并与同期非高白细胞急性髓系白血病(NHAML)患者进行比较。方法:观察随访66例HAML(WBC≥100×109/L)病例(非M3型),分析并发症、早期死亡(early death,ED)、治疗反应、远期预后等,并与同期随机选择的202例NHAML(WBC<100×109/L)病例(非M3型)进行比较。结果:①HAML病例发生低钾血症、出凝血异常、感染、肺白细胞淤滞、脾脏肿大、淋巴结肿大等并发症的概率高于NHAML病例(P<0.05)。HAML病例FAB分型以M4/M5型为主。②HAML病例ED 4例(6.1%),ED与出凝血异常(P<0.01)、肺白细胞淤滞(P<0.01)、CNS白细胞淤滞症状(P<0.01)相关。③HAML病例CR率66.7%,且M4/M5型CR率低。HAML病例3年DFS率为45.7%,3年OS率为32.5%。完全缓解(CR)率与年龄、是否为M4/M5型相关(P<0.05)。3年无病生存率(DFS)与是否>50岁及染色体分组相关(P<0.01)。3年总生存率(OS)与是否CR相关(P<0.05)。NHAML病例CR率为90.5%,3年DFS为44.7%,3年OS为45.6%,与HAML病例比较CR、3年OS差异有统计学意义(P<0.01),3年DFS差异无统计学意义(P>0.05)。即使去除ED病例,二者的3年OS仍差异有统计学意义。结论:HAML病例具有其特有的临床特点。
Objective: To investigate the clinical features, prognosis and prognosis of patients with high white blood cell acute myeloid leukemia (HAML) and to compare with those of patients with non-high leukemia acute myeloid leukemia (NHAML). Methods: Sixty-six patients with HAML (WBC ≥100 × 109 / L) were followed up (non-M3), and complications such as early death (ED), treatment response and long-term prognosis were analyzed. 202 cases of NHAML (WBC <100 × 109 / L) cases (non-M3 type) were compared. Results: ①The incidence of hypokalemia in HAML patients was higher than that in NHAML patients (P <0.05). The incidence of complications such as coagulation abnormalities, infection, pulmonary leukocyte stasis, splenomegaly and lymphadenopathy were higher than those in NHAML patients. HAML cases FAB type M4 / M5-based. ② There were 4 ED cases (6.1%) in EDL patients, and ED were associated with coagulation abnormalities (P <0.01), pulmonary leukocyte stasis (P <0.01) and CNS leucocyte stasis symptoms (P <0.01). The CR rate of HAML was 66.7%, and the rate of CR of M4 / M5 was low. The 3-year DFS rate of HAML was 45.7%, and the 3-year OS rate was 32.5%. The complete remission (CR) rate was related to age and M4 / M5 type (P <0.05). The 3-year disease-free survival (DFS) was associated with age> 50 years and chromosomal grouping (P <0.01). The 3-year overall survival (OS) was associated with CR (P <0.05). The CR rate of NHAML patients was 90.5%, the 3-year DFS was 44.7%, and the 3-year OS was 45.6%. There was significant difference between CR and 3-year OS in HAML patients (P <0.01), but there was no significant difference in 3-year DFS (P> 0.05). Even removing ED cases, the three-year OS was still statistically significant. Conclusion: HAML patients have their own specific clinical features.