c-D 指数是急性髓系白血病患者化疗期间发热性中性粒细胞减少持续时间的一个危险因素。
c-D-index is a risk factor for prolonged febrile neutropenia during chemotherapy in patients with acute myeloid leukemia.
机构信息
Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, Kagawa, 761-0793, Japan.
出版信息
Int J Clin Oncol. 2019 May;24(5):590-595. doi: 10.1007/s10147-018-01384-9. Epub 2019 Jan 2.
BACKGROUND
D-index is a recently established clinical tool for assessing neutropenia severity. This study examined whether the D-index can predict the onset of various infections in patients with febrile neutropenia (FN).
METHODS
We retrospectively investigated FN events in consecutive patients aged < 65 years who were treated for newly diagnosed acute myeloid leukemia at our institution. We collected data on all FN events during chemotherapy and evaluated the association of FN severity with infectious events.
RESULTS
This study included 35 patients (18 women and 17 men; median age, 51 years [range 18-65 years]) with 122 FN events. The response rate to induction chemotherapy was 60% (21/35), and all but one patient survived the treatment. The D-index did not predict FN onset. However, in multivariate analysis, high-dose cytarabine and total D-index were statistically significant explanatory factors for microbiological-proven infections. In addition, multivariate analysis showed that diabetes mellitus is the only risk factor for FN onset. Furthermore, older age, consolidation therapy, and cumulative D-index (c-D-index) were risk factors for prolonged FN. The FN period was the longest in patients with respiratory infections.
CONCLUSION
The D-index did not predict the onset of infection. However, FN duration might be prolonged during consolidation therapy in elderly patients with diabetes mellitus, and it is important to manage respiratory infections. These findings indicate the c-D-index is a useful tool to predict prolonged FN.
背景
D 指数是一种新建立的评估中性粒细胞减少症严重程度的临床工具。本研究探讨了 D 指数是否可以预测发热性中性粒细胞减少症（FN）患者各种感染的发生。
方法
我们回顾性调查了我院连续收治的年龄<65 岁的新发急性髓系白血病患者的 FN 事件。我们收集了所有化疗期间 FN 事件的数据，并评估了 FN 严重程度与感染事件的相关性。
结果
本研究共纳入 35 例患者（18 例女性，17 例男性；中位年龄 51 岁[18-65 岁]），共发生 122 例 FN 事件。诱导化疗的缓解率为 60%（21/35），除 1 例患者外，其余患者均存活。D 指数不能预测 FN 的发生。然而，多变量分析显示，大剂量阿糖胞苷和总 D 指数是微生物学证实感染的统计学显著解释因素。此外，多变量分析显示糖尿病是 FN 发生的唯一危险因素。此外，年龄较大、巩固治疗和累积 D 指数（c-D 指数）是 FN 持续时间延长的危险因素。发生呼吸道感染的患者 FN 持续时间最长。
结论
D 指数不能预测感染的发生。然而，在患有糖尿病的老年患者巩固治疗期间，FN 持续时间可能延长，管理呼吸道感染非常重要。这些发现表明 c-D 指数是预测 FN 持续时间延长的有用工具。
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