The Analysis Of Clinical Features In Patients With Chronic Myeloid Leukemia Accelerated Phase And Blast Crisis

Objective:To summarize the the clinical manifestations and characteristics of patients with chronic myeloid leukemia(CML)accelerated phase(AP)and blast crisis(BC),and analysis the factors which affecting the lifetime of the patients,provide valuable basis for clinical work.Methods:A retrospective analysis from March 2006 to March 2015,in the First Affiliated Hospital of Wangnan Medical College,according to the 2008 WHO diagnostic standard,46 patients were diagnosed chronic myeloid leukemia accelerated phase or blast phase.During these patients,31 cases were male,15 cases were female,19 cases in accelerated phase and 27 cases in blast crisis.A retrospective analysis of the clinical manifestations,signs,blood routine,blood biochemical(lactate dehydrogenase,uric acid),abdominal ultrasound,bone marrow biopsy,bone marrow cell morphology,characteristics,cytogenetics and molecular biology treatment,hematologic remission rate,survival time.The follow-up time is to the end of December 2015.Results:1.The most common clinical manifestations of the patients were abdominal distension,fatigue,fever,night sweats,cough,common signs were splenomegaly,sternal tenderness and lymph node enlargement.Approximately 11% of patients with extramedullary blast crisis.Bone marrow of most patients were hyperplasia activity,and bone marrow biopsy showed fibrous hyperplasia at different levels.2.Influencing factors of survival in 46 patients with advanced stage:Single factor analysis showed that hemoglobin >90g/L,white blood cell >50×109/L,TKI treatment group would had longer survival time,P values were 0.041,0.013 and 0.005.There was no significant correlation between the survival time of patients and gender,age,size of spleen and blood platelet,lactate dehydrogenase,uric acid.3.The group with TKI treatment or traditional chemotherapy :The group with TKI treatment who obtained complete hematologic remission rate during three monthes was 77%,the group with traditional chemotherapy group was33%,the difference was statistically significant(P=0.003).The influence factors of survival in two groups with Cox regression analysis,P values were greater than 0.05.4.Clonal evolution of chromosome : complete cytogenetic examination was performed in 18 patients,and 12 with additional chromosomes.There was no difference in survival time(P=0.423)and the rate of hematologic remission(P=0.423)between the two groupsConclusion:1.Univariate analysis showed that patients with hemoglobin >90g/L and white >50 x 109/L had longer survival time.2.Compared with traditional chemotherapy,TKI can improve the curative effect and prolong the survival time of patients with CML-AP and CML-BC.