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60세 이상의 급성 골수성 백혈병 115명에 대한 후향적 분석

Acute myelogenous leukemia in the elderly (≥60): retrospective study of 115 patients

이종석|최인실|윤성수|윤탁|박선양|나임일|이근욱|오도연|김노경|김지현|김병국|송은기|신현춘
대한내과학회 (The Korean Association Of Internal Medicine)|2006.02|대한내과학회지 (The Korean Journal of Medicine)|제70권 제2호|pp. 196-206

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키워드

Elderly고령Prognosis예후Acute myelogenous leukemia급성 골수성 백혈병
주제분류내과학

초록

목적 : 급성 골수성 백혈병은 고령에 호발하는 질환이나 젊은 층의 급성 골수성 백혈병에 비해 예후가 불량하다. 저자들은 60세 이상의 급성 골수성 백혈병에 대한 임상적 특성을 분석하고, 예후인자로서 연령, 속발성 백혈병 유무, 세포유전학적 표식자, 백혈구 아세포분획도에 대해서 완전관해율 및 생존율을 비교하였다.방법 : 1995년 1월부터 2004년 12월까지 서울대 병원에 방문한 60세 이상 115명 환자에 대한 의무기록으로 임상적 특징과 검사소견을 조사하였으며, 예후인자와 각치료 방법에 따른 치료율 및 생존율의 차이를 Kaplan- Meier 방법에 의해 분석하였다.결과 : 115명에 대한 중간 연령은 66 (60∼86)세 였으며, M3 아형 8명을 제외한 107명 중 63 (63/107=58.9%)명이 표준 항암요법을 시행 받았으며, 42명에서 완전관해가 발생하여 66.7%의 완전관해율을 보였다. 전체적인 생존율은 5.2개월이었으나, 완전관해에 도달한 42명의 생존율은 15.5개월로 완전 관해에 도달치 못한 환자의 1.3개월 보다 훨씬 높았다(p<0.0001). 표준치료를 시행한 63명에서 관해유도 사망률은 17.5%로 다소 높았으나, 생존율 중간값은 대증 치료만 시행한 43명의 환자 집단과 유의한 차이를 보였다(11.5 vs 0.9months; p<0.0001). 69명의 60대는 38명의 70대에 비해 완전관해율(69.0 vs 61.9%; p=0.9)과 생존율(7.0 vs 4.4months; p=0.8)의 증가를 보였으나 통계학적 유의성은 없었다.

Abstract

Background : Acute myelogenous leukemia (AML) is frequently encountered in elderly patients whereas intensive chemotherapy yield lower rate of complete remission (CR) and survival than young patients. This study was aimed to review the clinical features and treatment outcomes of elderly patients (≥60) with AML. Methods : We respectively reviewed the clinical features, laboratory findings and outcomes of treatment from the medical records of 115 patients with the elderly AML (≥60), admitted in Seoul National University Hospital, between Jan.1995 and Dec.2004 Results : Their median age was 66 (60～86) years with male predominance (M:F=68:47). Complete response rate in patients with conventional chemotherapy was 66.7% (42 of 63 patients; 95% CI 50.2～78.4). Median overall survival (OS) was 5.2 months with clinical benefit in the conventional chemotherapy group, compared to supportive or palliative group (11.5 vs 0.9months; p<0.0001). In between two age groups, the sixties (n=69) showed higher CR rate (69.0 vs 61.9%; p=0.9) and longer median overall survival (7.0 vs 4.4months; p=0.8) than patients group of the seventies (n=38) but without statistical significance. Conclusions : Conventional induction chemotherapy improved survival rate than palliative or supportive treatment.(Korean J Med 70:196-206, 2006)

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