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

Abstract

Giriş: Akut lösemi tedavisi ile ilgili klinik çalışmalara genellikle önemli komorbiditeleri olmayan hastalar alınmaktadır. Bu nedenle literatürde bildirilen tedavi sonuçları gerçek hayattaki klinik gerçeklerle bağdaşmayabilmektedir. Gereç ve yöntem: Ocak 2003 ile Aralık 2008 tarihleri arasına ünitemizde yeni tanı konulan 147 AML hastası retrospektif olarak incelenmiştir. Hastaların ortanca yaşı 48 (16-85), 11 (%7,5) tanesi CBF tipi AML, 18 (%12,2) tanesi APL ve 118 (%80,3) tanesini de diğer AML hastaları oluşturmaktaydı. AML hastalarının %74,8’ine idarubisin-sitarabin (3+7), %13,6’sına mitoksantronsitarabin (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 uygulanmıştı. İndüksiyon 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 yaş ve ECOG performans durumu bulundu. Total sağkalımı etkileyen faktörler ise yaş (≤30 yaş %32 sağkalım, 30-59 yaş %37, ≥60 yaş %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 değişkenli analiz yapıldığında sadece ECOG performans durumu anlamlı değişken olarak bulunmuştur (p=0,003).

Keywords

• Erişkin akut miyeloblastik lösemi, total sağkalım, hastalıksız sağkalım

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