单体核型急性髓系白血病的细胞遗传学和预后特点

发布时间：2018-05-29 21:31

  本文选题：单体核型 + 白血病　； 参考：《北京协和医学院》2016年博士论文

【摘要】：研究目的探讨成人急性髓系白血病(AML)单体核型患者的细胞遗传学和预后特点。研究方法2002年9月至2014年11月在中国医学科学院血液病医院诊断、治疗的1236例成人初诊AML患者中96例细胞遗传学预后不良AML患者和1例预后中等单纯单体核型AML患者纳入研究,对比分析单体核型患者与其他不良细胞遗传学预后患者的临床特征。连续变量的组间比较采用独立样本t检验,分类变量的比较采用卡方检验,生存分析应用Kaplan-Meier法,各组生存曲线比较应用Log-Rank检验。结果97例患者中,单体核型者31例,占同期收治的AML患者的2.5%,中位年龄为40岁,与除外急性早幼粒细胞白血病的非单体核型患者相比,无显著差异(P=0.499)。按照美国西南治疗研究组预后分层标准,其中30例染色体异常≥3种的复杂核型者,归入预后不良组；另1例单纯单体核型者归入预后中等组；非单体核型者66例。染色体单体包括了所有的22对常染色体,单体核型常见的染色体单体为-17、-5、-7、-21、-8、-22。单体核型多伴发其他细胞遗传学高危核型,常见的是-5、-7、11q异常、5q-、17p异常。96例细胞遗传学不良预后患者中,单体核型患者中位总生存(OS)时间为6.1个月,非单体核型患者中位OS时间未达到,两组中位无复发生存(RFS)时间分别为3.1和18.6个月,差异均有统计学意义(P值分别为0.001和0.001)。49例复杂核型患者中,单体核型(30例)和非单体核型(19例)组中位OS时间分别为6.1和10.8个月(P=0.088),中位RFS时间分别为3.1和8.6个月(P=0.009)。将31例单体核型患者分为两组,一组是仅有一个常染色体单体伴其他常染色体结构异常(6例),另一组是有两个及以上单体伴或不伴结构异常(25例),两组患者的中位OS时间分别为2.5和6.1个月,中位RFS时间分别为4.5和2.5个月,OS及RFS差异并无统计学意义(P值分别为0.812和0.205)。结论单体核型AML主要见于细胞遗传学预后不良组中的复杂核型患者,在预后不良及复杂核型群体中单体核型患者具有比非单体核型患者更差的预后。
[Abstract]:Objective to investigate the cytogenetic and prognostic characteristics of monomeric karyotype of adult acute myeloid leukemia (AML). Methods from September 2002 to November 2014, 96 patients with AML with poor cytogenetic prognosis and 1 patient with moderate monomeric AML were enrolled in the study. 1236 adult patients with AML were diagnosed from September 2002 to November 2014. The clinical features of patients with monomeric karyotype and other patients with poor cytogenetic prognosis were compared and analyzed. The independent sample t test was used to compare the continuous variables, the chi-square test was used to compare the classified variables, the Kaplan-Meier method was applied to survival analysis, and the Log-Rank test was used to compare the survival curves of each group. Results among the 97 patients, 31 were monomeric karyotype, which accounted for 2.5% of AML patients in the same period. The median age was 40 years old. There was no significant difference compared with non-monomeric karyotype patients excluding acute promyelocytic leukemia (APC). According to the criteria of prognostic stratification, 30 cases of complex karyotypes with chromosomal abnormalities 鈮，

本文编号：1952454