Objective: This study aimed to retrospectively analyze the clinical characteristics and prognosis of patients with acute leukemia in the plateau. Methods: The clinical information of patients diagnosed with acute leukemia from February 2010 to April 2023 at the People's Hospital of Tibet Autonomous Region was reviewed and collected, including blood cell count, morphology, immunophenotype, cytogenetics, and molecular data. Survival analysis was conducted to analyze the outcome of patients with acute leukemia. Results: This study enrolled 105 patients with acute leukemia, including 24 with acute lymphoblastic leukemia (ALL), 62 with acute myeloid leukemia (AML), and 19 with acute leukemia without baseline data. Of the patients with ALL, 11 underwent bone marrow testing for immunophenotype, all of whom were B-cell lineage. The main FAB subtype of patients with AML was M(2) (25/57), followed by M(3) (12/57), M(5) (6/57), M(4EO) (5/57), M(1) (4/57), M(4) (4/57), and M(0) (1/57). The complete remission rates of patients with ALL, acute promyelocytic leukemia (APL), and AML (non-APL) after one course of induction therapy were 57.1% (8/14), 100% (6/6), and 53.6% (15/28), respectively. The median event-free survival (EFS) and overall survival (OS) for patients with ALL were 2 (95% CI 0-9) and 3 (95% CI 0-9) months, respectively, with a median followup of 37 (95% CI 17-57) months. Patients with APL did not reach median EFS or OS, whereas the median EFS and OS for core binding factor AML (CBF-AML) cases were 10 (95% CI 0-21) months and 13 (95% CI 3-23) months, respectively, and patients with non-CBF-AML had inferior median EFS (2 months, 95% CI 1-3) and OS (2 months, 95% CI 1-3) (P<0.01). Patients with ALL treated from 2020 to 2023 demonstrated trends toward better EFS (P=0.16) and OS (P=0.10) than those treated from 2010 to 2019. Similarly, trends toward superior EFS (P=0.27) and OS (P=0.12) were observed in patients with AML treated from 2016 to 2023, in comparison with those treated from 2010 to 2015. Conclusion: Progress in the treatment and prognosis of patients with acute leukemia in the plateau has been observed in recent years, which can be further promoted by precision diagnosis and tailored regimens.
目的： 描述及分析高原地区急性白血病患者的临床特征及疗效。 方法： 回顾性统计分析2010年2月至2023年4月西藏自治区人民医院收治的急性白血病患者的临床资料，包括血常规、细胞形态学、流式细胞术免疫分型、分子生物学及细胞遗传学等，对患者进行随访，并进行生存分析。 结果： 研究共纳入105例急性白血病患者，包括急性淋巴细胞白血病（ALL）24例、急性髓系白血病（AML）62例，无系别资料的急性白血病患者19例。11例具备流式细胞术免疫分型资料的ALL患者均为B-ALL。57例AML患者具有分型资料FAB亚型以M(2)为主（25例），其次为急性早幼粒细胞白血病12例，M(5) 6例，M(4EO) 5例，M(1) 4例，M(4) 4例，M(0) 1例。经1个疗程诱导化疗后可评价疗效者48例，其中ALL 14例，APL 6例，AML（非APL）28例，完全缓解（CR）率分别为57.1%（8/14）、100%（6/6）、53.6%（15/28）。中位随访37（95%CI 17~57）个月，ALL患者的中位无事件生存（EFS）期为2（95%CI 0~9）个月，中位总生存（OS）期为3（95%CI 0~9）个月；APL患者中位EFS期及OS期未达到；核心结合因子相关AML（CBF-AML）患者的中位EFS期及OS期分别为10（95%CI 0~21）个月、13（95%CI 3~23）个月，非CBF-AML（包括无染色体核型及融合基因资料患者）患者的中位EFS期及OS期均为2（95%CI 1~3）个月，不同亚型AML患者的EFS期及OS期差异有统计学意义（P值均<0.01）。按收治年份将ALL患者分成2010-2019年和2020-2023年两组，后者较前者EFS（10个月对1个月，P=0.16）及OS（15个月对1个月，P=0.10）呈改善趋势；按收治年份将AML患者分成2010-2015年和2016-2023年两组，后者较前者EFS（10个月对3个月，P=0.27）及OS（12个月对3个月，P=0.12）呈改善趋势。 结论： 高原地区急性白血病疗效虽然较国内发达地区仍有差距，但近年来已取得了较大进展，推进急性白血病精准诊断和治疗有利于改善患者预后。.
Keywords: Leukemia, lymphoblastic, acute; Leukemia, myeloid, acute; Plateau; Prognosis.