Zhao Hongli, Zhao Yanqiu, Zhang Yingmei, Hou Jinxiao, Yang Huiyuan, Cao Fenglin, Yang Yiju, Hou Wenyi, Sun Jiayue, Jin Bo, Fu Jinyue, Li Haitao, Wang Ping, Ge Fei, Zhou Jin
Department of Hematology, The First Affiliated Hospital, Harbin Medical University, No.23, Youzheng Street, Nangang District, Harbin, 150001, China.
Department of Hematology, The Fourth Affiliated Hospital, Harbin Medical University, Harbin, China.
Ann Hematol. 2018 Mar;97(3):409-416. doi: 10.1007/s00277-017-3216-2. Epub 2017 Dec 30.
Early death (ED) remains the most critical issue in the current care of patients with acute promyelocytic leukemia (APL). Very limited data are available regarding ED in patients with relapsed APL. In this retrospective study, 285 de novo and 79 relapsed patients were included. All patients received single-agent arsenic trioxide as induction therapy. The differences in baseline clinical features, incidence, causes, and prognostic factors of ED were compared between the two patient cohorts. The relapse cohort exhibited a better overall condition than the de novo cohort upon hospital admission. The ED rate in the relapsed patients (24.1%) was somewhat higher than that in the de novo patients (17.9%), although the difference was not significant (P = 0.219). For both cohorts, hemorrhage was the main cause of ED, followed by differentiation syndrome, infection, and other causes. Increased serum creatinine level, older age, male sex, white blood cell (WBC) count > 10 × 10/L, and fibrinogen < 1 g/L were independently risk factors for ED in the de novo patients, whereas WBC count > 10 × 10/L, elevated serum uric acid level, and D-dimer > 4 mg/L were independent risk factors for ED in the relapsed patients. These data furnish clinically relevant information that might be useful for designing more appropriate risk-adapted treatment protocols aimed at reducing ED rate in patients with relapsed APL.
早期死亡（ED）仍然是当前急性早幼粒细胞白血病（APL）患者治疗中最关键的问题。关于复发APL患者的早期死亡，现有数据非常有限。在这项回顾性研究中，纳入了285例初发患者和79例复发患者。所有患者均接受单药三氧化二砷作为诱导治疗。比较了两个患者队列在基线临床特征、早期死亡的发生率、原因和预后因素方面的差异。复发队列在入院时的总体状况优于初发队列。复发患者的早期死亡率（24.1%）略高于初发患者（17.9%），尽管差异不显著（P = 0.219）。对于两个队列，出血都是早期死亡的主要原因，其次是分化综合征、感染和其他原因。血清肌酐水平升高、年龄较大、男性、白细胞（WBC）计数>10×10⁹/L和纤维蛋白原<1g/L是初发患者早期死亡的独立危险因素，而白细胞计数>10×10⁹/L、血清尿酸水平升高和D-二聚体>4mg/L是复发患者早期死亡的独立危险因素。这些数据提供了临床相关信息，可能有助于设计更合适的风险适应性治疗方案，以降低复发APL患者的早期死亡率。
