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YENİ TANILI AKUT MİYELOBLASTİK LÖSEMİ HASTALARINDA HASTALIK ÖZELLİKLERİ VE TEDAVİ SONUÇLARINI ETKİLEYEN FAKTÖRLER: TEK MERKEZ DENEYİMİ

DISEASE CHARACTERISTICS AND FACTORS INFLUENCING TREATMENT RESPONSE IN NEWLY DIAGNOSED ACUTE MYELOBLASTIC LEUKEMIA PATIENTS: A SINGLE CENTER EXPERIENCE

Journal Name:

  • İstanbul Tıp Fakültesi Dergisi

Publication Year:

  • 2010

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Abstract (2. Language): 
Objective: Generally, patients who have no important co-morbidities are evaluated in acute leukemia studies. Because of this reason, the treatment results in literature may be incompatible with real life. Materials and methods: Data of 147 newly diagnosed adult AML patients followed in our institute between January 2003 and December 2008 were retrospectively reviewed. Median age was 48 (range 16-85) and, 11(7.5%) had Core-Binding-Factor (CBF) AML, 18(12.2%) had Acute Promyelocytic AML (APL) and 118 (80.3%) had other AML. The 74.8% of patients received idarubicine+cytarabine (3+7), 13.6% received mitoxantrone+cytarabine (3+7), 2.9% received high dose cytarabine+mitoxantrone, 0.9% received cytarabine, 0.9% received mitoxantrone+cytarabine+etoposide, 1.9% received idarubicine+cytarabine (2+5) and 4.8% received AIDA protocols. Results: The mean hemoglobin, white blood cell and platelet counts were 8.6 g/dl (3.5-14), 41 359/mm3 (600-300.000) and 64 086/mm3 (3000–459.000), respectively. 12 (8.1%) of the patients received allogeneic stem cell transplantation. The response rates in patients after the induction regimens: 52.4% achieved complete remission (CR), 27.2% died during induction (induction mortality) and 5.4% had resistant disease. The OS rate at 5.9 years was 29%. DFS rate at 5 years was 44% in patients of remission obtained with induction. Conclusion: In univariate analysis, age and ECOG performance status were associated with complete response. The age (≤30 32%, 30-59 37%, ≥60 13%, p= 0.003), ECOG performance status (ECOG≤1 33%, ECOG>1 17%, p= 0.001) and AML karyotype (CBF AML 72%, APL 41%, other AML 24%, p= 0.043) were associated with overall survival. In multivariate analysis, only ECOG performance status (p=0.003) was found associated with overall survival.
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Abstract (Original Language): 
GiriĢ: Akut lösemi tedavisi ile ilgili klinik çalıĢmalara genellikle önemli komorbiditeleri olmayan hastalar alınmaktadır. Bu nedenle literatürde bildirilen tedavi sonuçları gerçek hayattaki klinik gerçeklerle bağdaĢmayabilmektedir. Gereç ve yöntem: Ocak 2003 ile Aralık 2008 tarihleri arasına ünitemizde yeni tanı konulan 147 AML hastası retrospektif olarak incelenmiĢtir. Hastaların ortanca yaĢı 48 (16-85), 11 (%7,5) tanesi CBF tipi AML, 18 (%12,2) tanesi APL ve 118 (%80,3) tanesini de diğer AML hastaları oluĢturmaktaydı. AML hastalarının %74,8’ine idarubisin-sitarabin (3+7), %13,6’sına mitoksantron-sitarabin (3+7), %2,9’una yüksek doz sitarabin-mitoksantron, %0,9’una sitarabin, %0,9’una etoposid-mitoksantron-sitarabin, %1,9’una idarubisin-sitarabin (2+5) ve %4,8’ine (akut promiyelositik lösemi hastaları) modifiye AIDA kemoterapi protokolü verildi. Bulgular: Ortalama hemoglobin, beyaz küre ve trombosit değerleri sırasıyla 8,6 g/dl (3,5-14), 41 359/mm3 (600-300,000) ve 64,086/mm3 (3000-459,000) idi. Toplam 12 (%8,1) hastaya allojeneik kök hücre nakli uygulanmıĢtı. Ġndüksiyon tedavisi ile %52,4 tam yanıt, %27,2 indüksiyon esnasında eks ve %5,4 oranında da yanıtsız olarak bulundu. Tüm hastaların 5,9 yıllık total sağkalım oranı %29 ve indüksiyonla remisyon sağlanan hastalarda 5 yıllık hastalıksız sağkalım oranı %44 idi. Sonuç: Tam yanıtı etkileyen faktörler sırasıyla yaĢ ve ECOG performans durumu bulundu. Total sağkalımı etkileyen faktörler ise yaĢ (≤30 yaĢ %32 sağkalım, 30-59 yaĢ %37, ≥60 yaĢ %13, p= 0,003), ECOG performansı (ECOG≤1 %33 sağkalım, ECOG>1 %17, p= 0,001) ve AML tipi (CBF tipi AML’de %72 sağkalım, APL hastalarında %41, diğer AML hastalarında %24, p= 0,043) olarak bulundu. Çok değiĢkenli analiz yapıldığında sadece ECOG performans durumu anlamlı değiĢken olarak bulunmuĢtur (p=0,003).
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  • Turkish

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