Analysis of prognostic factors in children with acute myeloid leukemia(M4/M5)
10.3760/cma.j.issn.2095-428X.2018.03.007
- VernacularTitle:儿童急性髓系白血病(M4/M5亚型)临床疗效及预后因素分析
- Author:
Kai CHEN
1
;
Hui JIANG
;
Zhenghua LU
;
Jingbo SHAO
;
Jingwei YANG
;
Hong LI
;
Na ZHANG
;
Jiashi ZHU
;
Bing ZOU
Author Information
1. 上海市儿童医院血液肿瘤科
- Keywords:
Acute myelomonocytic leukemia;
Acute monocytic leukemia;
Acute myeloid leukemia;
Chemothe-rapy;
Prognosis
- From:
Chinese Journal of Applied Clinical Pediatrics
2018;33(3):186-190
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the clinical efficacy and prognostic factors for M4/M5subtypes in chil-dren with acute myeloid leukemia(AML).Methods A retrospective analysis of the clinical data of M4/M5subtypes in Shanghai Children′s Hospital Affiliated to Shanghai Jiaotong University,from January 2009 to December 2014 was carried out.The long-term efficacy,prognosis and relapse factors were analyzed.Results The clinical data of 46 ca-ses were collected,among which 38 cases were treated with more than 2 courses,including 22 male,16 female,19 cases M4and 19 cases M5.The median age was 5 years.5-year overall survival(OS)rate and 5-year event-free survival (EFS)rate were(57.7 ± 9.3)% and(47.2 ± 8.9)%,and 5-year EFS of M4and M5were(52.4 ± 12.7)% and (45.4 ± 11. 9)%. Compared with the international risk stratification:5-year EFS rate of favorable-risk, intermediate-risk and poor-risk were(77.2 ± 12.4)%,(49.5 ± 14.9)% and(25.0 ± 19.8)%(χ2=6.305,P=0.043).Single factor analysis showed that extramedullary infiltration(χ2=4.828,P=0.028),Chromosome karyotype (χ2=10.178,P=0.017),the eighth day assessment(χ2=5.382,P=0.020)and course of treatment(χ2=4.771, P=0.029)were prognostic factors;multivariate analysis showed extramedullary infiltration(HR =5.323,95%CI:1.620-17.490,P=0.006)and less-than-6 courses of treatment(HR=6.186,95%CI:1.726-22.176,P=0.005)were the independent risk factors of affecting survival.Conclusions (1)Strengthening treatment and ade-quate courses of treatment are the critical to improve the overall curative effect in children with M4/M5subtypes.(2) Extramedullary infiltration was the risk factor for survival and recurrence in M4/M5subtypes.(3)It is suggested that the children who have the initial symptoms and molecular biology with poor prognostic factors choose hematopoietic stem cell transplantation as early as possible.
