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目的 :探讨急性髓细胞白血病 (acutemyelogenousleukemia ,AML)早期病死 (earlydeath ,ED)的高危因素以及高白细胞髓性白血病 (hyperleukocyticacutemyelogenousleukemia ,HAML)的首次化疗策略。 方法 :采用回顾性病例对照、多因素分析的方法对 30 1例AML、31例HAML进行研究。结果 :白细胞计数 (≥ 10 0× 10 9/L)、骨髓增生度 (极度活跃 )、体温 (≥ 39℃ )、血小板计数 (≤ 2 0× 10 9/L)及白血病类型 (M5)等指标进入Logistic多元回归方程 (P =0 0 0 0 0 ) ,OR值分别约 5 0、4 9、3 3、3 2和 2 2 ;HAML的首次化疗 ,采用常规剂量 (平均相对剂量强度≥ 0 5 )、含蒽环类方案 (DA)化疗发生ED的危险性分别为小剂量 (平均相对剂量强度 <0 5 )、其它方案 (HA或HOAP)化疗的 12倍 (P =0 0 34 6 )和 7 5倍 (P =0 0 479)。结论 :白细胞计数 (≥ 10 0× 10 9/L)、骨髓增生度 (极度活跃 )、体温 (≥ 39℃ )、血小板计数 (≤ 2 0× 10 9/L)及白血病类型 (M5)等 5个指标为AMLED的高危因素 ,其中以HAML最为重要 ,而HAML首次化疗 ,采用小剂量、非蒽环类方案化疗 ,可能有助于降低ED率。
Objective: To investigate the risk factors of early death (ED) in acute myeloid leukemia (AML) and the first chemotherapy strategy of hyperleukocyticacutemyelogenous leukemia (HAML). Methods: A retrospective case-control, multivariate analysis of 30 1 cases of AML, 31 cases of HAML were studied. Results: The indexes of white blood cell count (≥10 0 × 10 9 / L), myeloproliferation (extreme active), body temperature (≥ 39 ℃), platelet count (≤20 × 109 / L) and leukemia type (M5) Logistic multivariate regression equation (P = 0 0 0 0) was used, with OR values of about 50,49,3,332 and 2,2 respectively. For the first time of HAML chemotherapy, the conventional dose (mean relative dose intensity ≥ 0 5 ). The risk of developing ED with anthracycline-based chemotherapy (DA) was lower (mean relative dose intensity <0 5), 12-fold higher for HA or HOAP chemotherapy (P = 0 0 34 6) and 7 5 times (P = 0 0 479). CONCLUSIONS: The white blood cell count (≥10 × 109 / L), myeloid hyperplasia (extreme hyperactivity), body temperature (≥39 ℃), platelet count (≤20 × 109 / L) and leukemia type AMLED indicators of high risk factors, of which the most important HAML, and HAML chemotherapy for the first time, the use of small doses of non-anthracycline regimen chemotherapy may help reduce the ED rate.