The prognostic significance of cytopenia in chronic lymphocytic leukaemia/small lymphocytic lymphoma
The prognostic significance of cytopenia in chronic lymphocytic leukaemia/small lymphocytic lymphoma
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DOI：
10.1111/j.1365-2141.2008.07086.x
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发表时间：
2008-06-01
影响因子：
6.5
通讯作者：
Slager, Susan L.
中科院分区：
文献类型：
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作者：
Zent, Clive S.;Ding, Wei;Slager, Susan L.
慢性淋巴细胞白血病（CLL）患者发生细胞减少症可预测预后不良。从1995年1月1日至2004年12月31日在罗切斯特梅奥诊所血液科就诊的所有CLL患者（n = 1750）评估了细胞减少、细胞减少的病因和临床结果。423例（24.2%）患者发生细胞减少，303例（17.3%）患者可归因于CLL，其中228例（75%）患者患有骨髓（BM）衰竭，75例（25%）患者患有自身免疫性疾病（AID）。AID患者（中位9.1年）比BM衰竭患者（中位4.4年，P < 0.001）的起病后细胞减少的生存率明显更好。在CLL诊断1年内诊断出AID的患者（n = 35）与没有CLL相关细胞减少症的患者相比，诊断后的生存期相似（中位9.3年vs 9.7年，P = 0.881）。虽然骨髓衰竭引起的细胞减少预示着CLL的预后较差，但AID引起的细胞减少并不是一个不良预后因素。这些发现表明，目前的临床分期系统无法对aids所致的细胞减少患者进行有意义的分类。国家癌症研究所工作组96标准的修订应考虑分期CLL患者的细胞减少的病因。
The development of cytopenia in chronic lymphocytic leukaemia (CLL) patients can predict poor prognosis. All CLL patients seen in the Division of Hematology at Mayo Clinic Rochester from 1 January 1995 to 31 December 2004 (n = 1750) were evaluated for cytopenia, aetiology of cytopenia and clinical outcome. Cytopenia occurred in 423 (24.2%) patients and was attributable to CLL in 303 (17.3%) cases, with 228 (75%) of these having bone marrow (BM) failure and 75 (25%) having autoimmune disease (AID). Survival from onset of cytopenia was significantly better for patients with AID (median 9.1 years) compared to patients with BM failure (median 4.4 years, P < 0.001). Patients with AID diagnosed within 1 year of the diagnosis of CLL (n = 35) had similar survival from diagnosis compared to patients without CLL-related cytopenia (median 9.3 vs. 9.7 years, P = 0.881). Although cytopenia caused by BM failure predicted a poorer prognosis in CLL, cytopenia caused by AID was not an adverse prognostic factor. These findings suggest that patients with cytopenia due to AID cannot be meaningfully classified by the current clinical staging systems. Revisions of the National Cancer Institute Working Group 96 criteria should consider the aetiology of cytopenia in staging CLL patients.