Analysis Of Curative Effect And Prognostic Factors Of Elderly Patients With Acute Myeloid Leukemia

Objective:Due to its unique genetic and clinical characteristics,elderly patients with acute myeloid leukemia(AML)has the difficulty of treatment and poor prognosis.How to accurately assess the disease risk of elderly patients with AML,develop a reasonable therapeutic regimen and prolong the survival period is a common concern of experts.This study mainly analyzed the prognostic factors and explored the efficacy of different treatment regiments and their influences on the survival period.Methods:We collected the data of patients aged 60 years or older who were first diagnosed the AML(excluding APL)in Yantai Yuhuangding Hospital.The K-M survival analysis method was used to determine factors that influence the prognosisand,the proportional hazard model was used to analyze the factors that could independently prompt the prognosis.All patients were divided into standard chemotherapy group(IA,DA,MA),low dose chemotherapy group(CAG,D-CAG,descitabine)and palliative treatment group(low-dose cytarabine in order to reduce the WBC,hydroxyurea,support treatments),and compared the CR rate after the first course treatments,ORR and median survival time.Results:There were 222 cases of elderly AML patients,among whom 103 patients received standard chemotherapy,46 patients received low dose chemotherapy,and 73patients received palliative therapy.There were no significant differences in gender,age,platelet count or hemoglobin concentration,FAB typing,karyotype,and gene mutation.The WBC counts were higher in the palliative group than those in other two groups.The significant parameters of the univariate analysis were age,karyotype,therapeutic regimen and WBC counts at the first diagnosis.Multivariate analysis showed that therapeutic regimen(P=0.00),karyotype(P=0.001)and WBC counts at the first diagnosis(P=0.00)were independent prognostic factors.In the palliative treatment group,the median survival time was 6.5 months,the CR rate after the first course of treatments was 0 and the ORR was 2.74%.In the standard chemotherapy group,the median survival time was 19.0 months,the CR rate of the first course of treatments was 36.89%and the ORR was 63.11%.The median survival time was 27.0 months of low dose chemotherapy group,and the CR rate after the first course of treatments was 42.86%and the ORR was 64.29%.There were no significant difference between standard chemotherapy group and low dose chemotherapy group(P>0.05).For patients with hyperleucocyte,the median survival time was 9.6 months of low dose chemotherapy group,and the median survival time was 17.5 months in the standard chemotherapy group.The result was significantly different(P=0.033).The CR rates between the two groups were 31.25%vs 0,and the difference was not statistically significant(P=0.542).The ORR between the two groups were 71.88%vs 0,and the result had significant difference(P=0.034).There were 24 patients in the palliative treatment group,with 0.3 months of the median survival time and no remission.For high-risk karyotype patients,the median survival time was 5.0 months and ORR was 0 in the palliative treatment group.In standard chemotherapy group,the median survival time was 16.1 months,the CR rate was 21.43%,and the ORR was 50.00%.The median survival time in the low dose chemotherapy group was 16.9 months,the CR rate was 37.50%and the ORR was 37.50%.The difference between the two groups was not statistically significant(P>0.05).Conclusions:1.For patients with good prognosis(WBC<50×10~9/L at the first diagnosis,middle or low risk karyotype),standard or low dose chemotherapy had longer survival than palliative treatment;For patients with WBC?50×10~9/L at the first diagnosis,standard chemotherapy can achieve longer survival time and higher remission rate compared with low dose chemotherapy.For high-risk karyotype patients,there was no significant difference between the standard regimen and the low dose chemotherapy.2.The related factors include age,karyotype,therapeutic regimen and WBC counts at the first diagnosis;The independent factors were WBC?50×10~9/L at the first diagnosis,high-risk karyotype and palliative treatment.3.For patients with WBC?50×10~9/L at the first diagnosis,standard chemotherapy is recommended.Other patients are advised to choose either low dose chemotherapy or standard chemotherapy,both of which are equally effective.