Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
Division of Hematology and Oncology, Department of Pediatrics, Children's of Alabama, University of Alabama at Birmingham, Birmingham, Alabama.
Cancer. 2022 Jan 15;128(2):292-298. doi: 10.1002/cncr.33914. Epub 2021 Sep 8.
The survival of patients with acute promyelocytic leukemia (APL) has dramatically improved with the use of all-trans retinoic acid (ATRA) and arsenic trioxide (ATO). However, because of the complexity of the initial management, early mortality (EM) remains a major contributor to treatment failure. It is less known whether advances in treatment, urgent access to specialized care, and broad availability of ATRA/ATO have reduced EM in the last 2 decades. Furthermore, the influence of sociodemographic factors on the risk of EM also remains unclear.
This study used the Surveillance, Epidemiology, and End Results program to characterize the impact of sociodemographic factors on the rates of EM and overall survival (OS) in patients with APL diagnosed between 1992 and 2015.
In all, 2224 cases were identified (895 who were younger than 40 years and 1329 who were 40 years old or older); 47.9% had a county-level median household income of $59,630 or higher, 49.0% belonged to counties where more than 31% of adults held at least a bachelor's degree, and 86.0% resided in urban areas. The rate of EM declined from 31.5% in 1992-1995 to 15.9% in 2012-2015 for all patients. It improved for patients younger than 40 years (27.4% in 1992-1995 vs 5.4% in 2012-2015; P < .001) and for patients 40 years old or older but not to the same extent (35.2% in 1992-1995 vs 22.2% in 2012-2015; P = .02). Importantly, improvements in EM were not seen among patients residing in rural areas, with the rate remaining higher than 20% in 2012-2015. The 3-year OS rate was 49.2% for patients with APL diagnosed in 1992-1995 and 76.4% for patients diagnosed in 2012-2015.
These findings confirm consistent improvements in EM and OS for patients with APL and point to the challenge of further extending these improvements in EM rates to older patients and to those living in rural areas.
全反式维甲酸（ATRA）和三氧化二砷（ATO）的应用显著改善了急性早幼粒细胞白血病（APL）患者的生存。然而，由于初始治疗的复杂性，早期死亡率（EM）仍然是治疗失败的主要原因。在过去的 20 年中，治疗的进步、紧急获得专业护理以及 ATRA/ATO 的广泛应用是否降低了 EM，这一点还不太清楚。此外，社会人口因素对 EM 风险的影响也尚不清楚。
本研究利用监测、流行病学和最终结果计划，描述了社会人口因素对 1992 年至 2015 年间诊断为 APL 的患者的 EM 发生率和总生存率（OS）的影响。
共确定了 2224 例病例（其中 47.9%的人年龄在 40 岁以下，49.0%的人年龄在 40 岁或以上；47.9%的人所在县的家庭中位数收入为 59630 美元或更高，49.0%的人所在县有超过 31%的成年人至少拥有学士学位，86.0%的人居住在城市地区）。所有患者的 EM 发生率从 1992-1995 年的 31.5%下降到 2012-2015 年的 15.9%。对于年龄小于 40 岁的患者，这一比率有所改善（1992-1995 年为 27.4%，2012-2015 年为 5.4%；P <.001），但对于年龄在 40 岁或以上的患者，改善程度没有那么明显（1992-1995 年为 35.2%，2012-2015 年为 22.2%；P =.02）。重要的是，居住在农村地区的患者并没有看到 EM 改善，2012-2015 年的 EM 发生率仍高于 20%。1992-1995 年诊断为 APL 的患者 3 年 OS 率为 49.2%，2012-2015 年诊断为 APL 的患者为 76.4%。
这些发现证实了 APL 患者的 EM 和 OS 持续改善，并指出了进一步提高 EM 率在老年患者和农村地区患者中获益的挑战。
