Chang Ming-Chih, Chen Tsai-Yun, Tang Jih-Luh, Lan Yii-Jenq, Chao Tsu-Yi, Chiu Chang-Fang, Ho Hsin-Tsung
Department of Hematology-Oncology, Mackay Memorial Hospital and Mackay Medicine, Nursing and Management College, Taipei, Taiwan.
Am J Hematol. 2007 Nov;82(11):976-80. doi: 10.1002/ajh.20939.
To assess the role of leukapheresis and cranial irradiation in reducing the incidence of intracranial hemorrhage (ICH) and early death in patients with hyperleukocytic acute myeloid leukemia (AML) and the impact of such treatment on survival. This study retrospectively analyzed the records of 75 patients with hyperleukocytic AML who had a white cell count over 100,000/microL. All patients had de novo AML except for two with therapy-related AML. Various factors were assessed for their impact on morbidity and mortality, particularly the role of pre-induction leukapharesis and cranial irradiation. The most significant risk factors for ICH were the presence of two or more symptoms of leukostasis (odds ratios [OR] 10.6, 95% CI: 2.67-42.02; P = 0.001) and respiratory distress (OR 5.41, 95% CI: 1.44-20.32, P = 0.012). The most significant risk factors for early death were age >or= 65 (OR 4.21, 95% CI: 1.45-12.21, P = 0.008), respiratory failure (OR 3.34, 95% CI: 1.24-9.50, P = 0.018), and two or more symptoms (OR 3.50 95% CI: 1.16-10.52, P = 0.026). Neither leukapheresis nor cranial irradiation were significantly associated with a decreased incidence of ICH (P = 0.349 and 0.378, respectively). Leukapheresis had no significant influence on early death (P = 0.367). The median survival patients receiving no pretreatment was 10.50 months (range 2.58-18.42) and for those receiving pretreatment 1.50 months (range 0.10-3.16; log-rank test, P = 0.062). Leukapheresis and cranial irradiation do not improve survival or decrease the incidence of ICH in adults with hyperleukocytic AML.
评估白细胞去除术和头颅照射在降低高白细胞急性髓系白血病（AML）患者颅内出血（ICH）发生率和早期死亡风险中的作用，以及此类治疗对生存的影响。本研究回顾性分析了75例白细胞计数超过100,000/微升的高白细胞AML患者的记录。除2例与治疗相关的AML患者外，所有患者均为初发AML。评估了各种因素对发病率和死亡率的影响，特别是诱导前白细胞去除术和头颅照射的作用。ICH的最显著危险因素是存在两种或更多白细胞淤滞症状（比值比[OR]10.6，95%可信区间：2.67 - 42.02；P = 0.001）和呼吸窘迫（OR 5.41，95%可信区间：1.44 - 20.32，P = 0.012）。早期死亡的最显著危险因素是年龄≥65岁（OR 4.21，95%可信区间：1.45 - 12.21，P = 0.008）、呼吸衰竭（OR 3.34，95%可信区间：1.24 - 9.50，P = 0.018）和两种或更多症状（OR 3.50，95%可信区间：1.16 - 10.52，P = 0.026）。白细胞去除术和头颅照射均与ICH发生率降低无显著相关性（P分别为0.349和0.378）。白细胞去除术对早期死亡无显著影响（P = 0.367）。未接受预处理患者的中位生存期为10.50个月（范围2.58 - 18.42），接受预处理患者的中位生存期为1.50个月（范围0.10 - 3.16；对数秩检验，P = 0.062）。白细胞去除术和头颅照射并不能改善高白细胞AML成人患者的生存或降低ICH发生率。
