| Objective:To investigate the clinical characteristics and therapeutic efficacy of acute promyrlocytic leukemia(APL)in a single center(short-term efficacy and long-term outcomes),and to analyze the prognostic factors of APL.Methods:Retrospective analysis of 360 cases of newly diagnosed APL patients in the Cancer Center of the First Hospital of jilin University form Januayy 2009 to July 2016.The patients were treated with induction therapy,consolidation therapy and maintenance treatment.Bone marrow puncture was performed in 21 to 28 days after chemotherapy.The patients who completed induction therapy were included in survival analysis.Results:Three hundred and sixty patients of newly diagnosed APL patients were enrolled in this study,59 cases(16.4%)in the low-risk group,204 cases(56.7%)in the middle-risk group and 97 cases(26.9%)in the high-risk group.There were no significant difference among three groups on the hemoglobin level(F = 0.438,P = 0.153),the activation of partial coagulation time(APTT)(F =0.46,P=0.727),the patients with FBG<1.0 g/L(c 2=1.27,P = 0.53).While in the age of patients(F = 97.08,P<0.001),ibrinogen(FBG)level(F = 13.49,P = 0.012),the percentage of the patients with FBG<1.5g/L(c2 = 9.79,P = 0.007),PML-RAR? S(c2 = 12.15,P = 0.02)were significant difference among three groups.Of the 360 newly diagnosed patients,3 cases were given treatment and 29 cases had early death,with 328 patients with CR,and no treatment-related failure.The main reason for the early death of cerebral hemorrhage(65.5%),and the early death patients verus CR patients than in initial white blood cell count(P = 0.01),platelet count(P = 0.04)and risk stratification(P < 0.001)showed a significant difference,and PML-RAR? fusion gene and FLT3-TID(+)had no significant difference.The CR rate in low,medium and high risk groups were 98.3%,95.1%,and 80.9%,respectively and the difference was statistically significant(c2 = 21.41,P < 0.001).Three hundred and twenty-eight cases of CR patients,twenty-seven cases did not consolidate the treatment,more than 301 patients in 290 patients in our center received 2 to 3 courses of consolidation therapy.The complete remission rate of molecular biology was 99.2%(264/266).Median Dada molecular biology turned negative treatment number 2.Three groups of patients received the time of molecular biology negative(2.3 ± 1.9),(2.1 ± 0.8),(2.2 ± 1.0),the difference was not statistically significant(F = 0.094,P = 0.516).In the high-risk group,32 cases(47.1%)of patients with high-dose cytarabine and(2.2 ± 1.1)were in the middle of molecular biology negative,and the number of treatments for molecular biology(2.3 ± 1.0),the difference was not statistically significant(t = 0.08,P = 0.936).The median follow-up time was 33 months(3 ~ 91 months),and the 3-year OS rate was 95.4% and the 3-year RFS rate was 91.6%.The factors that may influence the prognosis of APL,such as age,sex,initial treatment leukocytes,risk stratification,FLT3-TID positive,CD56 expression,PML-RAR? fusion gene etc.were included in the analysis.Univariate analysis of the related factors for OS: CD56 positive expression was significantly lower than the control group(P = 0.024),consolidation therapy without ATRA was significantly lower than the ATRA group(P=0.013),the influence of other factors on the OS was not statistically significant.For the RFS: the number of newly diagnosed leukocytes ?10×109/L was significantly lower than that of newly diagnosed leukocytes <10×109/L(P = 0.017),high-risk groups was significantly lower than the low,and medium risk group(P = 0.035),CD56 positive expression was significantly lower than the control group(P= 0.004),consolidation therapy without ATRA was significantly lower than the ATRA group(P = 0.013),for case of molecular biology remission of 3 was lower than that in patients with 1 or 2 cycles(P= 0.035),the influence of other factors on the RFS is not statistically significant.Multivariate analysis showed that CD56 positive expression is independent risk factors for APL patients with regard to OS,newly diagnosed leukocytes,risk stratification and CD56 expression were independent risk factors for APL patients with regard to RFS.Conclusions:1.The overall CR rate of the study was 91.9%.The CR rate in low,medium and high risk groups were 98.3%,95.1%,and 80.9%,respectively(P < 0.001).The complete remission rate of molecular biology was 99.2%(264/266).2.The early death of patients was 8.1%,with high-risk groups of up to 19.1%.Compared with CR patients,there were statistically significant differences in the higher initial number of white blood cell(P = 0.01),the lower platelet count(P = 0.04)and risk stratification(P < 0.001),and PML-RAR? fusion gene and FLT3-TID(+)difference no statistically significant.3.The 3-year OS rate was 95.4% and the 3-year RFS rate was 91.6%.Univariate analysis showed: the factors that affecting OS were consolidation therapy with or without ATRA,CD56 expression.The factors that affecting RFS were white blood cell count,risk stratification,CD56 expression,consolidation therapy with or without ATRA,the case of molecular biology remission.Multivariate analysis indicated: the factors that affecting OS was the expression of CD56 and he factors that affecting RFS were newly diagnosed leukocytes,risk stratification and CD56 expression. |
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