急性髓系白血病细胞遗传学特征与诱导治疗反应的相关性分析

  目的　探讨急性髓系白血病（AML）细胞遗传学分布特征及其与诱导治疗反应的相关性。方法　对初诊为AML的395例患者的染色体核型进行分析，按照美国国立综合癌症网络（NCCN）白血病指南分为预后良好组、预后中等组和预后不良组。分析各组核型发生比及其1个疗程诱导治疗后的完全缓解（CR）率。结果　预后良好、中等及不良核型分别占50.56 %（180／356）、39.89 %（142／356）、9.55 %（34／356）。预后良好核型t（15；17） 113例中，接受并完成1个疗程诱导治疗的101例患者均达CR。单纯t（8；21）组与合并其他染色体异常的t（8；21）组CR率比较差异有统计学意义[92.00 %（23／25）比 50.00 %（11／22）]（χ2＝10.317，P＝0.001）。正常核型及-Y异常两组核型CR率比较差异无统计学意义[61.90 %（39／63） 比 58.82 %（10／17）]（χ2＝0.054，P＝0.817）。复杂核型中以单体核型最多见，经治疗的10例单体核型患者9例未达缓解。结论　初诊AML患者细胞遗传学分布特点与国际其他中心报道略有差异。AML患者细胞遗传学特征不仅与长期生存相关，而且与诱导治疗后CR率密切相关。

Clinical analysis of cytogenetic features in acute myeloid leukemia and its relationship with early responses after induction therapy

Objective　To study the cytogenetic features of acute myeloid leukemia (AML) and analyze the association with cytogenetic features and early responses after induction therapy. Methods　The karyotypes of 395 patients who had been newly diagnosed with AML were analyzed. These patients were divided into three groups (low-risk, intermediate-risk and high-risk), according to the AML NCCN guidelines. The incidence of different karyotypes in these three groups and the complete remission (CR) rate after the first cycle of induction therapy were analyzed. Results　The incidence rates of karyotypes in high-risk, intermediate-risk and low-risk groups were 50.56 % (180/356), 39.89 % (142/356),9.55 % (34/356), respectively. All patients with t(15;17) who completed induction therapy reached CR. There was significant difference in the CR rates of t(8;21) groups with or without additional karyotypes [92.00 %(23/25) vs 50.00 %(11/22)] (χ2 = 10.317, P = 0.001). There was no significant difference in the CR rates between normal and -Y karyotype group [61.90 % (39/63) vs 58.82 % (10/17)] (χ2 = 0.054, P = 0.817). Complex cytogenetics ascribed to the low-risk group, of which monosomal karyotype was common, nine of ten patients with monosomal karyotype were associated with an inferior CR rate. Conclusion　The cytogenetic features of AML are different from previous reports by other centers. The cytogenetic features of AML patients not only influence the long-term survival, but also the CR rates of induction therapy.