摘要
目的 :了解 80岁以上老年人急性粒细胞性白血病 (AML)的临床及生物学特征、影响预后的因素 ,分析保守支持治疗的可行性。方法 :回顾性分析经FAB分型确诊的 30例 80岁以上老年AML患者的临床及生物学特征、影响预后的因素及可行性治疗方案。结果 :确诊时 ,13例 (43.3% )ECOGPS评分 >2分〔1〕;10例 (33.3% )有MDS病史 ;2 4例 (80 .0 % )有并发症 ;9例 (30 .0 % )LDH≥ 4 0 0U/L ;13例 (43.3% )血清白蛋白≤ 32g/L ;预后不良核型 11例 (36 .7% ) ;CD34+ 、CD7+ 或CD14 + 者共 12例 (40 .0 % )。 12例 (40 .0 % )仅接受支持治疗 ,18例 (6 0 .0 % )给予支持治疗同时辅以小剂量化疗及GM/G CSF治疗。中位数生存期 (OS)为 13周 (2～ 6 0周 ) ,5例 (16 .7% )OS≥ 6个月 ,3例 (10 .0 % )OS≥ 12个月。单因素分析显示PS评分 >2分 ,血清白蛋白≤ 32g/L ,白细胞≥ 5 0× 10 9/L和预后不良核型为OS的负面影响因素。结论 :80岁以上AML患者有特殊的临床和生物学特征 ,治疗以保守治疗为主 ,必要时可根据病情辅以小剂量化疗 ,其预后与多种因素有关。
Objective:To analyze the clinical and biological features,prognostic factors and conservative treatment of acute myelogenous leukemia patients over 80 years old.Method:We retrospectively analyzed 30 acute myelogenous leukemia(AML )patients over 80 years old who were diagnosed from January 1992 to May 2002 in the Hematology Institute of Wuhan Union hospital(Wuhan, China).Result:PS>2 was found in 13 patients( 43.3 %) ,10( 33.3 %) had previous MDS and 24 ( 80.0 %) had concomitant diseases. The numbers of patients with LDH≥400 U/L and serum albumin≤32 g/L were 9 and 13, respectively. 11 patients had unfavorable karyotypes and 12 showed CD34 +,CD7 + orCD14 +. 12( 40.0 %) received only supportive care, whereas 18 ( 60.0 %) received palliative chemotherapy or with GM/G CSF if necessary to control leukocytosis. Median overall survival time was 13 weeks (range 2～60), 5( 16.7 %) and 3 ( 10.0 %) survived more than 6 and 12 months, respectively. In univariate analysis, PS>2, WBC≥50×10 9/L, the value of serum albumin ≤32 g/L and unfavorable karyotypes had an adverse prognostic significance on survival.Conclusion:AML in patients over 80 years presented their own clinical or biological features. And conservative treatment seems to be more suitable for these very elderly patients, GM/G CSF may be well if necessary.
出处
《临床血液学杂志》
CAS
2004年第1期16-18,共3页
Journal of Clinical Hematology
