Department of Hematology, Nanfang Hospital, Southern Medical University, Rd 1838 North Guangzhou Avenue, Guangzhou 510515, China.
Mediators Inflamm. 2020 Dec 23;2020:8867760. doi: 10.1155/2020/8867760. eCollection 2020.
Infections are an important cause of morbidity and mortality for acute lymphoblastic leukemia (ALL). However, the reports regarding risk factors of induction-related infection are roughly unknown/limited in adult T-ALL during induction chemotherapy.
We performed a retrospective cohort study for the prevalence and risk predictors of induction-related infection among consecutive T-ALL patients ( = 97) enrolled in a PDT-ALL-LBL clinical trial. Of 97 patients with T-ALL enrolled in the trial, 46 were early T-cell precursor (ETP) ALL and 51 were non-ETP ALL.
When compared with non-ETP, ETP ALL subtype was characterized with lower neutrophil count (1.35 × 10/L vs. 8.7 × 10/L, < 0.001) and lower myeloid percentage in the bone marrow (13.35% vs. 35.31%, = 0.007). Additionally, ETP ALL had longer neutropenia before diagnosis ( < 0.001), as well as during induction chemotherapy ( < 0.001). Notably, the ETP cohort experienced higher cumulative incidence of clinically documented infections (CDI; 33.33%, = 0.001), microbiologically documented infections (MDI; 45.24%, = 0.006), resistant infection (11.9%, = 0.013), and mixed infection (21.43%, = 0.003), respectively, than those of the non-ETP cohort. Furthermore, multivariable analysis revealed that T-ALL mixed infection was more likely related to chemotherapy response (OR, 0.025; 95% CI 0.127-0.64; = 0.012) and identified myeloid percentage as a predictor associated with ETP-ALL mixed infection (OR, 0.915; 95% CI 0.843-0.993; = 0.033), with ROC-defined cut-off value of 2.24% in ETP cohorts.
Our data for the first time demonstrated that ETP-ALL characterized with impaired myelopoiesis were more susceptible to induction-related infection among T-ALL populations.
感染是急性淋巴细胞白血病（ALL）患者发病率和死亡率的重要原因。然而，在诱导化疗期间，成人 T 细胞 ALL 患者诱导相关感染的危险因素报告大致未知/有限。
我们对一项 PDT-ALL-LBL 临床试验中连续入组的 97 例 T 细胞 ALL 患者的诱导相关感染发生率和危险因素进行了回顾性队列研究。97 例 T 细胞 ALL 患者中，46 例为早期 T 细胞前体（ETP）ALL，51 例为非 ETP ALL。
与非 ETP ALL 相比，ETP ALL 亚型的中性粒细胞计数较低（1.35×10/L 比 8.7×10/L， < 0.001），骨髓中髓系比例较低（13.35%比 35.31%， = 0.007）。此外，ETP ALL 在诊断前（ < 0.001）和诱导化疗期间（ < 0.001）中性粒细胞减少症持续时间较长。值得注意的是，ETP 组的临床确诊感染（CDI；33.33%， = 0.001）、微生物学确诊感染（MDI；45.24%， = 0.006）、耐药感染（11.9%， = 0.013）和混合感染（21.43%， = 0.003）的累积发生率均高于非 ETP 组。此外，多变量分析显示，T 细胞 ALL 混合感染更可能与化疗反应相关（OR，0.025；95%CI 0.127-0.64； = 0.012），并确定髓系比例是与 ETP-ALL 混合感染相关的预测因子（OR，0.915；95%CI 0.843-0.993； = 0.033），在 ETP 队列中的截断值为 2.24%。
我们的数据首次表明，在 T 细胞 ALL 人群中，具有髓系生成受损特征的 ETP-ALL 更容易发生诱导相关感染。
