Objective: To explore the risk factors affecting the survival and efficacy of patients with acute myeloid leukemia with myelodysplasia-related changes (AML-MRC) transformed from myelodysplastic syndrome (MDS).
Methods: The clinical data of 60 patients with AML-MRC transformed from MDS who hospitalized in The Third Affiliated Hospital of Soochow University from January 2010 to December 2021 were retrospectively analyzed. The demographic data and laboratory parameters, cytogenetic karyotypes, target genes of AML detected by next generation sequence, risk stratification, treatment regimen, therapeutic efficacy and survival outcome were documented. Rank sum test and Chi-square test or Fisher exact test were used to compare the survival and efficacy. The effects of clinical parameters, risk stratification and treatment regimens on the survival and efficacy of the AML-MRC patients were analyzed by univariate and multivariate analysis.
Results: The median overall survival (OS) of the AML-MRC patients was 4.5 months, the 1-year OS rate was 28.3%, and the complete remission (CR) rate after treatment was 33.3%. The univariate analysis showed that age≥60 years, leukocytosis, severe thrombocytopenia, poor-risk group and only accepted hypomethylating agents(HMAs) or supportive therapy were the risk factors affecting OS. COX multivariate analysis showed that thrombocytopenia ( HR=4.46), HMAs therapy (compared to transplantation, HR=10.47), supportive therapy (compared to transplantation, HR=25.80) and poor-risk group (compared to medium-risk group, HR=13.86) were independent hazard factors for median OS of patients with AML-MRC. The univariate analysis showed that the risk factors affecting 1-year OS in patients with AML-MRC were age≥60 years, thrombocytopenia, time of transformation from MDS to AML (TTA)≥3 months, fibrinogen-albumin ratio index (FARI)≥0.07, CONUT score≥5, poor-risk group and supportive therapy. Binary logistic regression analysis showed that the independent risk factors for 1-year OS in AML-MRC patients were age≥60 years ( HR=11.23), thrombocytopenia ( HR=8.71), FARI≥0.07 ( HR=5.19) and poor-risk group ( HR=14.00). The risk factors affecting CR of AML-MRC patients in univariate analysis were age≥60 years, thrombocytopenia, FARI≥0.1, CONUT score≥5, poor-risk group and supportive therapy, while binary logistic regression analysis showed that age≥60 years( HR=7.35), CONUT score≥5 ( HR=9.60), thrombocytopenia ( HR=12.05) and poor-risk group ( HR=32.5) were independent risk factors affecting CR of the patients.
Conclusion: The OS of AML-MRC patients is poor, old age(≥60 years old), supportive therapy, HMA therapy, poor-risk, thrombocytopenia, FARI≥0.07 and CONUT score≥5 may be associated with poor prognosis.
题目: 骨髓增生异常综合征进展的伴骨髓增生异常相关改变急性髓系白血病患者的生存及预后分析.
目的: 探讨由骨髓增生异常综合征（MDS）进展的伴骨髓增生异常相关改变急性髓系白血病（AML-MRC）的预后影响因素及患者生存情况。.
方法: 回顾分析2010年1月至2021年12月于苏州大学附属第三医院就诊的60例具有完整随访资料的由MDS进展的AML-MRC患者的临床资料，描述性分析AML-MRC的临床特征、遗传学特点、基因测序、预后分层、治疗方案等，对各项临床指标、预后分层和治疗方案等对AML-MRC患者生存及预后的影响进行单因素与多因素分析。.
结果: AML-MRC患者的中位生存时间（OS）为4.5个月，1年OS率为28.3%，治疗后的完全缓解（CR）率为33.3%。单因素分析结果显示，年龄≥60岁、初诊为AML-MRC时白细胞增多、血小板显著减少、预后分层差及HMA药物治疗和支持治疗为AML-MRC患者中位OS较短的危险因素；COX多因素分析结果显示，血小板显著减少（ HR=4.46）、HMA药物治疗（相对于移植， HR=10.47）、支持治疗（相对于移植， HR=25.80）与预后分层差（相对于预后中等， HR=13.86）为影响AML-MRC患者中位OS的独立不良预后因素。单因素分析结果显示，影响AML-MRC患者1年OS的危险因素为年龄≥60岁、血小板显著减少、由MDS进展为AML的间隔时间（TTA）≥3个月、纤维蛋白原/白蛋白比值（FARI）≥0.07、CONUT评为≥5分、预后分层差及支持治疗；二元Logistic回归分析结果显示，影响AML-MRC患者1年OS的独立危险因素为年龄≥60岁（ HR=11.23）、血小板显著减少（ HR=8.71）、FARI≥0.07（ HR=5.19）及预后分层差（ HR=14.00）。单因素分析显示，影响患者CR的危险因素为年龄≥60岁、血小板显著减少、FARI≥0.1、CONUT评分≥5分、预后分层差及支持治疗；二元Logistic回归分析结果显示，年龄≥60岁（ HR=7.35）、预后分层差（ HR=32.5）、CONUT评分≥5分（ HR=9.60）及血小板显著减少（ HR=12.05）为影响患者CR的独立危险因素。.
结论: AML-MRC患者总体中位OS时间短，可能造成AML-MRC患者不良预后的因素有高龄（≥60岁）、支持治疗、HMA治疗、预后分层差、血小板显著减少、FARI≥0.07、营养状况差（CONUT评分≥5分）。.
Keywords: acute myeloid leukemia; myelodysplasia-related changes; myelodysplastic syndrome; prognosis; survival.