继发性急性髓系白血病的治疗反应和结局及其影响因素分析

OBJECTIVE: To evaluate treatment responses, outcomes, and prognostic factors in adults with secondary acute myeloid leukemia（sAML）. METHODS: Between January 2008 and February 2021,date of consecutive cases of younger than 65 years of adults with sAML were assessed retrospectively. Clinical characteristics at diagnosis, treatment responses, recurrence, and survival were evaluated. Logistic regression and Cox proportional hazards model were employed to determine significant prognostic indicators for treatment response and survival. RESULTS: 155 patients were recruited, including 38，46，57，14 patients belonging to t-AML, and AML with unexplained cytopenia，post-MDS-AML, and post-MPN-AML，respectively. In the 152 evaluable patients, the rate of MLFS after the initial induction regimen was 47.4％, 57.9％, 54.3％, 40.0％, and 23.1％ in the four groups（P＝0.076）. The total rate of MLFS after the induction regimen was 63.8％, 73.3％, 69.6％, 58.2％, and 38.5％（P＝0.084）, respectively. Multivariate analysis demonstrated that male gender（OR＝0.4, 95％ CI 0.2–0.9, P＝0.038 and OR＝0.3, 95％ CI 0.1–0.8, P＝0.015）, SWOG cytogenetic classification into unfavorable or intermediate（OR＝0.1, 95％ CI 0.1–0.6, P＝0.014 and OR＝0.1, 95％ CI 0.1–0.3, P＝0.004）and receiving low-intensity regimen as induction regimen（OR＝0.1, 95％ CI 0.1–0.3, P＝0.003 and OR＝0.1, 95％CI 0.1–0.2, P＝0.001）were typical adverse factors impacting the first CR and the final CR; PLT<45 × 10(9)/L（OR＝0.4, 95％CI 0.2–0.9, P＝0.038）and LDH ≥258 U/L（OR＝0.3, 95％CI 0.1–0.7, P＝0.005）were independent factors for CR. Among the 94 patients with achieving MLFS, 46 cases had allogeneic hematopoietic stem cell transplantation. With a median follow-up period of 18.6 months, the probabilities of relapse-free survival（RFS）and overall survival（OS）at 3 years were 25.4％ and 37.3％ in patients with transplantation, and in patients with chemotherapy, the probabilities of RFS and OS at 3-year were 58.2％ and 64.3％, respectively. At the time of achieving MLFS, multivariate analysis revealed that age ≥46 years（HR＝3.4, 95％CI 1.6–7.2, P＝0.002 and HR＝2.5, 95％CI 1.1–6.0, P＝0.037）, peripheral blasts ≥17.5％ at diagnosis（HR＝2.5, 95％CI 1.2–4.9, P＝0.010 and HR＝4.1, 95％CI 1.7–9.7, P＝0.002）, monosomal karyotypes（HR＝4.9, 95％CI 1.2–19.9, P＝0.027 and HR＝28.3, 95％CI 4.2–189.5, P＝0.001）were typical adverse factors influencing RFS and OS. Furthermore, CR after induction chemotherapy（HR＝0.4, 95％CI 0.2–0.8, P＝0.015）and transplantation（HR＝0.4, 95％CI 0.2–0.9, P＝0.028）were substantially linked to longer RFS. CONCLUSION: Post-MDS-AML and post-MPN-AML had lower response rates and poorer prognoses than t-AML and AML with unexplained cytopenia. In adults with male gender, low platelet count, high LDH, and SWOG cytogenetic classification into unfavorable or intermediate at diagnosis, and receiving low-intensity regimen as the induction regimen predicted a low response rate. Age ≥46 years, a higher proportion of peripheral blasts and monosomal karyotype had a negative effect on the overall outcome. Transplantation and CR after induction chemotherapy were greatly linked to longer RFS.