Song Yu-Hua, Peng Peng, Qiao Chun, Zhang Run, Li Jian-Yong, Lu Hua
Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital.
Department of Hematology, The Second Hospital of Nanjing, Nanjing, People's Republic of China.
Onco Targets Ther. 2017 Oct 9;10:4917-4924. doi: 10.2147/OTT.S144438. eCollection 2017.
The objective of the current study was to provide more appropriate therapeutic strategies for reducing severe hemorrhaging by assessing the recovery of abnormal coagulation indexes in patients with acute promyelocytic leukemia (APL) during induction therapy. Retrospective analyses of 112 patients newly diagnosed with APL were performed during initial treatment. In our study, the early death rate was 5.36%. Hemorrhage was the leading cause of death during the induction period (4/6). The values of white blood cell count, lactate dehydrogenase, prothrombin time (PT), fibrinogen (Fbg), hemoglobin, and bone marrow leukemic promyelocytes were significantly different in the high-risk group compared to the low/intermediate-risk groups. There were significant differences in the white blood cell count, bone marrow leukemic promyelocytes, platelet (PLT) count, and the levels of lactate dehydrogenase, d-dimer, PT, and Fbg, as well as in FLT3-ITD mutations between patients with major bleeding and those with minor bleeding. Hemostatic variables significantly improved over time during induction therapy. The recovery times of the PLT, PT, and Fbg values were significantly slower in patients with major bleeding than in those with minor bleeding. Specifically, the PLT level in patients with major bleeding was not similar to that in the minor bleeding group until after 4 weeks of treatment. Hemorrhages were the most common cause of induction death in this study. High-risk patients were more prone to serious clinical bleeding symptoms. Patients with major bleeding had more rapid proliferation characteristics and an increased incidence of FLT3-ITD mutations compared to patients with minor bleeding. Hemostatic variables recovered significantly more slowly in patients with major bleeding than in those with minor bleeding. Active induction therapy and blood product infusion are effective in preventing severe bleeding. Our results suggested that low PLT count might be the leading cause of fatal bleeding in patients newly diagnosed with APL.
本研究的目的是通过评估急性早幼粒细胞白血病（APL）患者诱导治疗期间异常凝血指标的恢复情况，为减少严重出血提供更合适的治疗策略。对112例新诊断为APL的患者在初始治疗期间进行了回顾性分析。在我们的研究中，早期死亡率为5.36%。出血是诱导期死亡的主要原因（4/6）。与低/中危组相比，高危组的白细胞计数、乳酸脱氢酶、凝血酶原时间（PT）、纤维蛋白原（Fbg）、血红蛋白和骨髓白血病早幼粒细胞的值有显著差异。大出血患者和小出血患者在白细胞计数、骨髓白血病早幼粒细胞、血小板（PLT）计数、乳酸脱氢酶、D-二聚体、PT和Fbg水平以及FLT3-ITD突变方面存在显著差异。诱导治疗期间，止血变量随时间显著改善。大出血患者的PLT、PT和Fbg值恢复时间明显慢于小出血患者。具体而言，大出血患者的PLT水平直到治疗4周后才与小出血组相似。出血是本研究中诱导死亡最常见的原因。高危患者更容易出现严重的临床出血症状。与小出血患者相比，大出血患者具有更快的增殖特征和更高的FLT3-ITD突变发生率。大出血患者的止血变量恢复明显慢于小出血患者。积极的诱导治疗和血液制品输注可有效预防严重出血。我们的结果表明，低PLT计数可能是新诊断APL患者致命出血的主要原因。
