急性白血病合并银屑病的临床分析

【作者】 王迎；

【导师】 王建祥；

【作者基本信息】 中国协和医科大学 ， 内科学， 2008， 博士

【摘要】 【目的】初步探讨急性白血病合并银屑病患者的临床特征、预后及其影响因素。【方法】对我院100例急性白血病合并银屑病患者的临床特征、疗效和生存情况进行回顾性分析。【结果】100例患者根据银屑病治疗情况分为三组:乙双吗啉治疗组(35例)、非乙双吗啉治疗组(45例)、未治疗组(20例)。三组患者的银屑病类型均以寻常型为主,男性多于女性,乙双吗啉治疗组中银屑病病程超过10年的患者多于另外两组(P＜0.05)。白血病各亚型例数的顺序为M3＞M2b＞M5＞M4＞M4eo＞ALL＞M1/M2a/M6,三组患者所患白血病的类型构成比无显著统计学差异(P＞0.05),最常见的白血病类型均为AML-M3,其次均为AML-M2b,两者约占总体的3/4左右。70例患者进行了染色体核型检查,染色体畸变发生率为72.9%,有44.3%出现非重现性染色体畸变。非重现性的染色体数目畸变中最常见的是单体Y。三组患者出现非重现性克隆性染色体结构畸变的比例分别为42.9%、17.1%、21.4%,乙双吗啉治疗组明显高于另两组(P＜0.05)。三组患者的完全缓解(CR)率分别为73.3%、89.7%、83.3%,一疗程CR率分别为56.7%、87.2%、66.7%,非乙双吗啉治疗组的一疗程CR率明显高于另两组(P＜0.05)。初诊时有淋巴结肿大、银屑病病程超过10年者CR率更低;初诊时无出血症状、银屑病病程短于10年、非乙双吗啉治疗组的患者更容易一疗程获得CR(P＜0.05)。三组患者的中位总生存(OS)时间分别为8月、152月和108月,预期的5年OS率分别为31.2%、60.3%和54.6%,乙双吗啉治疗组中位OS时间明显短于另两组,5年OS率低于另两组(P＜0.01)。三组中位无复发生存(RFS)时间分别为3月、84月和53月,预期的5年RFS分别为27.2%、58.9%和51.6%,乙双吗啉治疗组的中位RFS时间明显短于另两组,5年RFS率低于另两组(P＜0.01)。COX回归分析发现初诊时WBC＞10×10~9/L和获得CR所需的疗程数为OS独立的预后不良因素,初诊时外周血幼稚细胞比例越高、出现非重现性克隆性染色体结构畸变以及获得CR所需的疗程数为RFS独立的预后不良因素。AML-M3患者CR率89.6%,总的中位OS时间为152(0.03～206)月,5年的OS率和RFS率分别为65.5%、62.5%。对OS时间和RFS时间均有影响的是初诊时WBC、外周血幼稚细胞比例以及PML/RARα随访情况(P＜0.01)。COX回归多因素分析未发现对OS和RFS时间有统计学意义的独立预后因素。【结论】伴有银屑病的急性白血病患者以AML-M3和AML-M2b最为常见,染色体核型异常发生率高,提示银屑病患者可能存在遗传不稳定性。曾用过乙双吗啉及其类似物的患者易出现非重现性染色体结构畸变,化疗缓解率低,远期生存较差。更多还原

【Abstract】 Objective To investigate the clinical feature and prognosis of acute leukemia with psoriasis, and to analyze influence factors on prognosis.Methods The clinical feature,curative effect and survival of 100 cases of acute leukemia with psoriasis were retrospectively analyzed.Results 100 cases of acute leukemia with psoriasis were divided into three groups according to the different treatment of psoriasis,35 cases treated with bimolane,45 treated cases not taking bimolane and 20 cases untreated. The major type of psoriasis was universal psoriasis. There were more patients with exceeding 10 years course of psoriasis in bimolane group than in the two other groups (P<0.05) .Totally,subtype frequency was shown as follows: M3>M2b>M5>M4>M4eo>ALL >M1/M2a/M6. There was no significant difference in the constituent ratio of leukemia subtype in three groups(P>0.05). The most frequent subtypes were AML-M3 and AML-M2b which was three quarters of overall.Chromosome aberrations(CA) were detected in 51 of 70 patients(72.9%) by chromosome banding analysis,and unrecurrent CA were detected in 44.3% of the patients.Numerical aberration analysis showed the most common unrecurrent CA was monosomic Y.The rates of unrecurrent clonal structural CA in bimolane group,non-bimolane group and untreated group were 42.9%,17.1%,21.4%, respectively. The rate of bimolane group was more than which of the two other groups (P<0.05) .The rates of hematological complete remission(CR) in bimolane group,non-bimolane group and untreated group were 73.3%,89.7%,83.3%, respectively. The rates of hematological complete remission(CR) after one course induction therapy in bimolane group,non-bimolane group and untreated group were 56.7%,87.2%,66.7%, respectively (P<.05) .The rate of CR was lower in the patients with lymphadenectasis or exceeding 10 years course of psoriasis. CR was achieved after one course induction therapy more easily in the patients without hemorrage,those in non-bimolane group or those with less than 10 years course of psoriasis (P<0.05) . The median overall survival(OS) times of bimolane group,non-bimolane group and untreated group were 8 months, 152 months and 108 months, respectively. The 5-year OS rates of three groups were 31.2%,60.3% and 54.6%, respectively. The median OS time and 5-year OS rate of bimolane group were lower than those of the two other groups (P<0.01 ) . The median relapse-free survival (RFS) times of bimolane group, non-bimolane group and untreated group were 3 months, 84 months and 53 months, respectively. The 5-year RFS rates of three groups were 27.2%,58.9% and 51.6%, respectively. The median RFS time and 5-year RFS rate of bimolane group were lower than those of the two other groups(P<0.01). By analyzing with COX regression, we found that OS was influenced by WBC and courses for CR,the patients with WBC exceeding 10×10~9/L or achieved CR after more than one induction therapy had worse prognosis. The bad prognosis factors for RFS were higher rate of blast cells in peripheral blood, with unrecurrent clonal structural CA and achieved CR after more than one course induction therapy.The rate of CR in AML-M3 was 89.6%.In total, the median OS time was 152 months. The 5-year OS rate and RFS rate of AML-M3 patients were 65.5% and 62.5%, respectively. OS and RFS was influenced by initial WBC count, rate of blast cells in peripheral blood and the status of PML/RARαin follow-up (P<0.01) . By multivariate study with COX regression, we did not found independent prognostic factors for OS and RFS.Conclusion The most frequent subtypes of acute leukemia with psoriasis were AML-M3 and AML-M2b. Frequent occurrence of CA indicated that patients with psoriasis had chromosome instability. The patients treated with bimolane or analogs occurred unrecurrent structural CA easily,and had low rate of remission and bad long-term survival.更多还原