Analysis Of Prognostic Factors On Long-term Survival Of Acute Promyelocytic Leukemia

Objective:To investigate the main factors influencing long-term survival in patients with acute promyelocytic leukemia(APL),and to provide clinical approaches for improving the prognosis and prolonging survival time of patientsMethods:234 newly diagnosed patients with APL admitted to Department of Hematology of Second Affilicated Hospital of Nanchang University For nearly 30 years.Calculating 5-year overall survival(OS) rates of 1975-1989 and 1990-2003 with life-table method respectively.Calculating complete remission(CR) rate and 5-year long-term survival rate of post-CR with direct method.Univariate analysis of sex,age,White Blood Cell(WBC),platelet(PLT),hemoglobin(HGB),bone marrow abnormal promyelocyte cell,serum ferritin(SF),lactate dehydrogease(LDH),karyotype, immunophenotype,fusion gene,clinical symptoms(fever,hemorrhage, lymphadenectasis,hepatospleno-megaly),DIC,induction-program,time to CR1,time of post-CR therapy,were carried out.Summing up the factors that were statistically significant and using COX regression model for multivariate analysis.Results:83 cases of 234 patients with APL achieved more than 5 years long-term survival.5-year overall survival(OS) rates of 1975-1989 and 1990-2003 were 4.0% and 57.0%respectively.CR rates of CH group and CH+ATRA group was 56.57%and 95.15%respectively,the difference was significant(P＜0.05),5-year long-term survival rates of post-CR were 7.1%and 73.5%respectively(P＜0.05).Univariate analysis revealed age,number of WBC,number of PLT,proportion of bone marrow abnormal promyelocyte cell,immunophenotype,karyotype,induction-program,time to CR1,time of post-CR therapy which were important prognostic for long-term survival.Sex,fever,bleeding,lymphadenectasis and hepatosplenomegaly,SF, LDH,PML/RARαfusion gene status were not associated with long-term survival. The efficacy of patients in APL with DIC by combined ATRA+CH group showed significantly higher than the CH group(P＜0.05).Analysis of COX regression model: Risk factor of the proportion of bone marrow abnormal promyelocyte cell was 5.690, Risk factor of immunophenotype was 7.387,Risk factor of karyotype was 3.020,Risk factor of DIC was1.823,Risk factor of time to CR1 was 2.353.Regression coefficients of number of PLT,time of post-CR therapy,induction-program were:-0.228,-1.570, -0.298 respectively.Conclusions:1.OS of CH+ATRA group in patients with APL was significantly higher than that of CH group.2.CR rate and long survival rate of post-CR in CH+ATRA group patients with APL was significantly higher than that of CH group.3. Sex,fever,hepatosplenomegaly and lymphadenectasis,bleeding;SF,LDH,had no effect on the long-term survival.4.ATRA+CH program help to improve bleeding and coagulation disorder in patients with APL,improve the cure rates of DIC,improve the CR rates 5.The proportion of bone marrow abnormal promyelocyte cells＞70%, time to CR1＞30 days,CD34 positive immunophenotype,the non-typical karyotype, DIC complicated,were independent risk factors to long-term survival.Number of PLT≥30.0×10~9/L,ATRA+CH induction-program,time of post-CR therapy≥3 years were favorable factors of long-term survival.