Division of Public Health, Office of Infectious Disease Epidemiology, Delaware Health and Social Services, Dover, DE, USA.
Department of Pulmonary Medicine, Section of Thrombosis and Benign Hematology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Thromb Res. 2017 Aug;156:14-19. doi: 10.1016/j.thromres.2017.05.019. Epub 2017 May 24.
The purpose was to determine the incidence and risk factors for venous thromboembolism (VTE) recurrence among adult acute leukemia patients. We performed a retrospective study of adult acute leukemia patients who were treated at our institution between November 1999 and May 2005. Medical records of 139 patients with an initial VTE were reviewed and followed up to May 2010 for VTE recurrence. Of these 139 patients [86 with acute myelogenous leukemia (AML), 53 with acute lymphocytic leukemia (ALL)], 27 (19.4%, 16 AML and 11 ALL) had VTE recurrence. The overall incidence rate of VTE was 8.6 per 100 person-years (median follow-up time: 0.9years). It was 5.9 and 12.4 per 100 person-years among ALL and AML patients, respectively. The cumulative proportion of recurrent VTE was 2.16%, 10.9%, 16.6%, 25.9%, 30.6%, and 34.2% at 1month, 6months, 1year, 3years, 5years, and 7years, respectively. In a multivariate Cox hazards model, significant predictors for VTE recurrence included catheter thrombosis [adjusted hazard ratio (aHR)]:6.3, 95%CI:1.17-34.0), prior history of hematologic cancer (aHR:4.2, 95%CI:1.5-11.2), chronic lung disease (aHR: 3.4, 95%CI:0.92-12.5), psychological disorder (aHR: 4.3, 95%CI:1.5-12.2), and liver disease (aHR: 3.8, 95%CI: 1.04-14.3). VTE recurrence is common among adult acute leukemia patients and it continues up to 7years after the initial episode. Catheter thrombosis, a history of hematologic malignancy antecedent to acute leukemia, and lung, liver and psychiatric co-morbidities increase the patient risk for VTE recurrence. Further studies should be conducted to improve the prevention of VTE recurrence in leukemia patients.
目的在于确定成人急性白血病患者静脉血栓栓塞症（VTE）复发的发生率和风险因素。我们对 1999 年 11 月至 2005 年 5 月在我院接受治疗的成人急性白血病患者进行了回顾性研究。对 139 例初始 VTE 患者的病历进行了回顾，并随访至 2010 年 5 月，以观察 VTE 复发情况。在这 139 例患者中[86 例为急性髓细胞性白血病（AML），53 例为急性淋巴细胞性白血病（ALL）]，27 例（19.4%，16 例 AML 和 11 例 ALL）出现 VTE 复发。VTE 的总体发生率为 8.6/100 人年（中位随访时间：0.9 年）。ALL 和 AML 患者的 VTE 发生率分别为 5.9/100 人年和 12.4/100 人年。在 1 个月、6 个月、1 年、3 年、5 年和 7 年时，复发性 VTE 的累积比例分别为 2.16%、10.9%、16.6%、25.9%、30.6%和 34.2%。在多变量 Cox 风险模型中，VTE 复发的显著预测因素包括导管血栓形成[调整后的风险比（aHR）]：6.3，95%CI：1.17-34.0）、先前存在血液系统恶性肿瘤史（aHR：4.2，95%CI：1.5-11.2）、慢性肺部疾病（aHR：3.4，95%CI：0.92-12.5）、心理障碍（aHR：4.3，95%CI：1.5-12.2）和肝脏疾病（aHR：3.8，95%CI：1.04-14.3）。成人急性白血病患者 VTE 复发较为常见，且在初次发病后持续至 7 年。导管血栓形成、急性白血病前的血液系统恶性肿瘤病史以及肺部、肝脏和精神合并症会增加患者 VTE 复发的风险。应开展进一步的研究，以改善白血病患者 VTE 复发的预防。
