Objective: To compare and analyze the clinical characteristics of acute myeloid leukemia (AML) related to the treatment of hematological tumors and solid tumors. Methods: The laboratory and clinical data of 41 patients with treatment-related AML (t-AML) in the Department of Hematology, Henan Cancer Hospital from January 2014 to December 2021 were retrospectively analyzed, and they were divided into hematological tumor group and solid tumor group. Survival analysis was performed using the Kaplan-Meier method and Log rank test. Results: The median interval from the first tumor diagnosis to t-AML in 41 patients was 21.0 (16.5-46.0) months; 24 (58.5%) had abnormal expression of lymphoid antigen, 28 (68.3%) had abnormal karyotype, 18 cases (43.9%) were positive for fusion gene, and 28 cases (68.3%) were positive for gene mutation; the median recurrence-free survival (RFS) was 11.0 months, and the median overall survival (OS) was 11.5 months. The proportion of acute promyelocytic leukemia ([APL], 0.0, 0/13), complete response ([CR],18.2%, 2/11), median OS (4.5 months) and median RFS (2.5 months) of t-AML patients in the hematological tumor group were significantly lower than those in the solid tumor group (35.7%, 10/28; 68.0%, 17/25; not reach; not reach), but the proportion of M4 /M5 (93.2%,12/13) was significantly higher than that in the solid tumor group (53.6%,15/18; all P values<0.05). Through subgroup analysis, the proportion of patients with positive PML-RARa and good prognosis karyotypes in the solid tumor group (35.7%, 10/28; 46.4%, 13/28) was significantly higher than that in the hematological tumor group (0.0, 0/13; 0.0, 0/13; P<0.05), while the proportion of patients with intermediate karyotypes (42.9%, 12/28) was significantly lower than that in the hematological tumor group (84.6%, 11/13; P<0.05), the difference was statistically significant. The CR rate (90.0%, 9/10), median OS (not reach) and median RFS (not reach) in the t-APL group were higher than those in the t-AML (without t-APL) group (38.5%, 10/26; 6 months; 8 months; P<0.05). After excluding the effect of t-APL patients, there was no significant difference in the CR rate, median OS and median RFS between the solid tumor group (8; 9 months; not reach) and the hematological tumor group (2; 4 months; 2 months; P>0.05). Univariate analysis showed that the primary tumor belongs to hematological tumor was a common risk factor for OS and RFS in t-AML patients (P<0.10). Conclusions: Compared with patients with t-AML secondary to solid tumors, patients with t-AML secondary to hematological tumors have poorer treatment effects and poorer prognosis. After excluding the effect of t-APL patients, there are no significant differences in the treatment efficacy and prognosis between the two types of t-AML patients.
目的： 探讨血液肿瘤和实体瘤治疗相关的急性髓系白血病（t-AML）的临床特点。 方法： 回顾性分析2014年1月至2021年12月河南省肿瘤医院41例t-AML患者的临床病理资料，分为血液肿瘤组t-AML（n=28）和实体瘤组t-AML（n=13）。生存分析采用Kaplan-Meier法和Log rank检验。 结果： 41例患者第一肿瘤至t-AML的中位发病间隔时间为21.0个月（16.5～46.0个月）；24例（58.5%）伴淋系抗原异常表达，28例（68.3%）染色体核型异常，18例（43.9%）融合基因阳性，28例（68.3%）基因突变阳性；中位无复发生存时间（RFS）为11.0个月，中位总生存时间（OS）为11.5个月。血液肿瘤组t-AML患者急性早粒细胞白血病（APL）比例（0.0，0/13）、达到完全缓解（CR）的比例（18.2%，2/11）、中位OS（4.5个月）和中位RFS（2.5个月）低于实体瘤组［分别为35.7%（10/28）、68.0%（17/25）、均未达到］，但M4/M5比例（93.2%，12/13）高于实体瘤组［53.6%（15/18），均P＜0.05］。实体瘤组PML-RARa基因阳性和预后良好核型比例［分别为35.7%（10/28）和46.4%（13/28）］高于血液肿瘤组［0.0（0/13）和0.0（0/13），均P＜0.05］，而预后中等核型比例（42.9%，12/28）低于血液肿瘤组［84.6%（11/13），P＜0.05］。治疗相关急性早幼粒细胞白血病（t-APL）组患者CR比例（90.0%，9/10）、中位OS（未达到）和中位RFS（未达到）均高于无APL的t-AML组［分别为38.5%（10/26）、6和8个月，均P＜0.05］。剔除t-APL患者影响后，实体瘤组患者CR患者例数8例、中位OS（9个月）和中位RFS（未达到）与血液肿瘤组（分别为2例、4和2个月）比较，差异均无统计学意义（均P＞0.05）。单因素分析结果显示，原发肿瘤为血液肿瘤是影响t-AML患者OS和RFS的危险因素（均P＜0.10）。 结论： 与实体瘤继发的t-AML患者比较，血液肿瘤继发的t-AML患者治疗效果差，预后差；剔除t-APL患者的影响后，血液肿瘤与实体瘤治疗相关的t-AML患者间治疗效果和预后无明显差异。.