Giles F J, Shen Y, Kantarjian H M, Korbling M J, O'Brien S, Anderlini P, Donato M, Pierce S, Keating M J, Freireich E J, Estey E
Departments of Leukemia, Biostatistics, and Blood and Marrow Transplantation, University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Box 61, Houston, TX 77030, USA.
Leuk Lymphoma. 2001 Jun;42(1-2):67-73. doi: 10.3109/10428190109097677.
Current published data on therapeutic leukapheresis in hyperleucocytic AML does not define the impact on survival from this procedure. Between 1992 and 1999 we saw 146 patients with newly-diagnosed AML (APL excluded) and an initial WBC count > 50 x 10(9)/L of whom 71 underwent leukapheresis at the discretion of their treating doctors. We compared outcome (early mortality, CR, and overall survival) rates in the patients who were and were not pheresed. After accounting for covariates relevant to these outcomes, including age, performance status, and cytogenetics, there was evidence (p = .006) that pheresis reduced 2-week mortality rate and a suggestion (p = .06) that this resulted in a higher CR rate. However there was no evidence that pheresis lengthened longer-term or overall survival; if anything the suggestion was the converse (p = .06). These data may reflect the fact that the patients chosen to have pheresis were prognostically unfavorable as defined by variables that were not captured in our data set, since the alternative explanation i.e. that pheresis per se shortens overall survival seems less likely. Whether the above justifies the use of pheresis in the absence of evidence from a randomized trial is doubtful, but it seems likely that any long-term benefit to be derived from this procedure must await further advances in anti-leukemia therapy.
目前已发表的关于高白细胞急性髓系白血病（AML）治疗性白细胞单采的数据并未明确该操作对生存率的影响。1992年至1999年间，我们诊治了146例新诊断的AML患者（不包括急性早幼粒细胞白血病），初始白细胞计数>50×10⁹/L，其中71例根据主治医生的判断接受了白细胞单采。我们比较了接受和未接受单采的患者的结局（早期死亡率、完全缓解率和总生存率）。在考虑了与这些结局相关的协变量，包括年龄、体能状态和细胞遗传学后，有证据表明（p = 0.006）单采降低了2周死亡率，并且有迹象表明（p = 0.06）这导致了更高的完全缓解率。然而没有证据表明单采延长了长期生存率或总生存率；如果有什么不同的话，迹象表明情况相反（p = 0.06）。这些数据可能反映了这样一个事实，即选择进行单采的患者在预后方面不利，这是由我们数据集中未涵盖的变量所定义的，因为另一种解释，即单采本身会缩短总生存率，似乎不太可能。在缺乏随机试验证据的情况下，上述情况是否足以证明使用单采是合理的值得怀疑，但似乎从该操作中获得的任何长期益处都必须等待抗白血病治疗的进一步进展。
