摘要
目的探讨急性早幼粒细胞白血病(APL)患者的临床、实验室特征、疗效并分析与预后相关的因素。方法对四川大学华西医院131例APL患者的临床症状、实验室检查、治疗措施、疗效评价及转归进行回顾性研究。结果①总体缓解率、早期病死率及3年复发率分别为86.11%、13.89%、18.6%;②单因素分析初诊时白细胞计数、血小板计数、DIC是不良预后因素,多因素分析仅DIC是预后不良因素;③免疫表型CD34(+),HLA-DR(+)及淋系抗原表达的患者3年复发率高于CD34(-)、HLA-DR(-)及无淋系抗原表达患者,但差异无统计学差异意义;④融合基因PML/RARα阳性率为96.9%,PML/RARαV(+)及阴性者3年复发率高于PML/RARαS(+)及L(+)患者,但差异无统计学意义;⑤诱导方案使用ATRA+化疗及ATRA+ATO组3年复发率低于单用ATO或ATRA患者,但4组比较差异无统计学意义。结论初诊时白细胞、血小板计数、DIC对临床预后具有一定价值,ATRA+ATO+化疗可以减少3年复发率。
Objective This study was aimed to study the features of the clinical and laboratory data and the therapeutic regimens of patients with acute promyelocytic leukemia,then analyse the correlation factors with prognosis.Methods Retrospective analysis was used in the study.Clinical data including clinical symptoms,laboratory data,therapeutic measure and therapeutic effect were collected and analysed.Results ①131 patients were included in our study,the complete remission（CR）rate,the early-death-rate,and the 3-year recurrence rate was 86.11%,13.89% and 18.6% respectively.②Univariate analyses showed that initial WBC count,PLT count and whether DIC has occurred were important prognostic factors for long-term survival.Multivariate study showed that only DIC was negative prognostic factor.③There was no significant difference in CR rate and relapse rate between these patients with variant immunophenotypic features.But the three-year relapse rate was higher in patient with CD34（＋）,HLA-DR（＋）and lymphoid antigen（＋） compared to CD34（-）,HLA-DR（-）and lymphoid antigen（-） group.④Molecular biology subtype： the positive rate of PML/RARα fusion gene transcripts was 96.9%.There was no obvious difference between the L（＋）group,S（＋）group,V（＋）group and the PML/RARα（-）group of the CR and relapse rate.⑤Patients who received ATRA＋chemotherapy and ATRA＋ATO as induction therapy had lower relapse rate than those received ATRA or ATO alone.Conclusicon The analysis showed that the initial WBC count,PLT count and whether DIC has occurred were important prognostic factors for long-term survival,and the combination of ATRA and ATO and chemotherapy can reduce the 3-year recurrence rate.
出处
《四川医学》
CAS
2010年第4期434-437,共4页
Sichuan Medical Journal
