The relationship between induction chemotherapy cycles and prognosis in patients with acute myeloid leukemia

目的 探讨急性髓系白血病(AML)患者诱导治疗达完全缓解(CR)所需疗程与预后的关系.方法 回顾性分析2004年4月至2013年12月收治的397例成人初发AML(急性早幼粒细胞白血病除外)患者的治疗反应、复发和生存情况,初始诱导治疗应用去甲氧柔红霉素联合阿糖胞苷(IA “3+7”)方案,CR后给予巩固化疗,有移植条件的患者在第1次缓解期行异基因造血干细胞移植(allo-HSCT).结果 在397例患者中可评估的CR患者为347例,存活的CR患者中位随访时间18.0(2.4～115.4)个月,CR患者3年累积复发率(CIR)、无病生存(DFS)率和总生存(OS)率分别为33.0％、58.6％和67.1％.多因素分析显示:细胞遗传学危险度高、达CR所需疗程数多、未行allo-HSCT是影响DFS和OS的共同危险因素,FLT3-ITD突变阳性是影响DFS的独立危险因素.1个疗程达CR(255例)和2个疗程达CR(73例)的患者之间DFS和OS率差异均无统计学意义(P＞0.05),而两组患者的DFS(P值分别为0.002和0.030)和OS率(P值分别为0.006和0.061)均优于≥3个疗程达CR组(19例).在183例持续化疗患者中,多因素分析显示:2个疗程内达CR是改善DFS和OS的共同独立预后因素(P值分别为0.001和0.035).结论 IA方案初始诱导治疗AML,2个疗程内获得CR有利于改善CR患者的DFS和OS.To explore the relationship between induction chemotherapy cycles to achieve complete remission (CR) and prognosis in patients with acute myeloid leukemia(AML).From April 2004 to December 2013, 397 adult patients with newly diagnosed AML (acute promyelocytic leukemia excluded) received the idarubicin combined with cytarabine (IA)"3+7" regimen as the first induction chemotherapy were enrolled in the study. Therapeutic effect, relapse and survival of these patients were discussed. Patients underwent continuous consolidation chemotherapy, and some eligible patients received allogeneic hematopoietic stem cell transplantation (allo-HSCT) in the first complete remission.Of 397 patients, 347 evaluable patients achieved CR after 1-4 cycles induction chemotherapy.The median follow-up was 18.0 (2.4-115.4) months in survivors, the cumulative incidence of relapse (CIR), disease-free survival (DFS) and overall survival (OS) at 3 years were 33.0%, 58.6% and 67.1%, respectively. Multivariate analysis revealed that unfavorable cytogenetics, more cycles to achieve CR and post-remission treatment without allo-HSCT were independent risk factors affecting DFS and OS. FLT3-ITD mutation positive was another independent risk factor affecting DFS. There was no statistic difference between patients who achieved CR after one cycle (n=255) and two cycles (n=73) treatment in DFS and OS (P>0.05). DFS and OS in patients who achieved CR after 3 or 4 cycles(n=19)were significantly lower than the above two groups (P<0.05). Multivariate analysis among 183 patients who received consistent chemotherapy showed that achieving CR within 2 cycles was the favorable factor affecting DFS and OS (P=0.001, P=0.035).Achieving CR within 2 cycles of induction chemotherapy was associated with better prognosis among adult CR patients with AML.PubMed中文核心期刊要目总览(PKU)中国科技核心期刊(ISTIC)中国科学引文数据库(CSCD)0289-943