Mendes Fernanda Rodrigues, da Silva Wellington Fernandes, da Costa Bandeira de Melo Raphael, Silveira Douglas Rafaele Almeida, Velloso Elvira Deolinda Rodrigues Pereira, Rocha Vanderson, Rego Eduardo Magalhaes
Division of Hematology, Instituto do Cancer do Estado de São Paulo (ICESP), Faculdade de Medicina da Universidade de Sao Paulo, Av. Dr. Arnaldo, 251, Cerqueira César, São Paulo, CEP 01246-000, Brazil.
Laboratory of Medical Investigation in Pathogenesis and Targeted Therapy in Onco-Immuno-Hematology (LIM-31), Department of Hematology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil.
Ann Hematol. 2022 Jan;101(1):147-154. doi: 10.1007/s00277-021-04687-6. Epub 2021 Oct 21.
Despite advances in supportive measures, acute myeloid leukemia (AML) remission induction still has a high mortality rate in real-world studies as compared to prospective reports. We analyzed data from 206 AML adult patients treated with conventional chemotherapy. The primary endpoint was the 60-day mortality rate, aiming to find risk factors and to examine the role of anti-infection prophylaxis. The 60-day mortality rate was 26%, raising to 41% among those older than 60 years. Complete response was documented at the end of induction in 49%. The final survival model showed that age > 60 years (HR 3.2), Gram-negative colonization (HR 3), monocytic AML (HR 1.8), C-reactive protein (CRP) > 15 mg/dL (HR 10), and an adverse risk in the genetic stratification (HR 3) were associated with induction death. Multidrug-resistant bacteria colonization, thrombosis, and AKI were documented in 71%, 12%, and 66% of the cohort, respectively. Antibacterial and antifungal prophylaxis did not improve outcomes in this study. Our report corroborated the higher mortality during AML induction compared to real-world data from the USA and Europe. In line with other publications, age and cytogenetic stratification influenced early death in this cohort. Noticeably, Gram-negative colonization, monocytic AML, and CRP were also significant to early mortality.
尽管支持性措施有所进步，但与前瞻性报告相比，急性髓系白血病（AML）缓解诱导在实际研究中的死亡率仍然很高。我们分析了206例接受传统化疗的成年AML患者的数据。主要终点是60天死亡率，旨在寻找危险因素并检验抗感染预防的作用。60天死亡率为26%，60岁以上患者中这一比例升至41%。诱导结束时记录的完全缓解率为49%。最终生存模型显示，年龄>60岁（HR 3.2）、革兰氏阴性菌定植（HR 3）、单核细胞性AML（HR 1.8）、C反应蛋白（CRP）>15 mg/dL（HR 10）以及基因分层中的不良风险（HR 3）与诱导死亡相关。该队列中分别有71%、12%和66%的患者记录了多重耐药菌定植、血栓形成和急性肾损伤。在本研究中，抗菌和抗真菌预防并未改善结局。我们的报告证实了与美国和欧洲的实际数据相比，AML诱导期间的死亡率更高。与其他出版物一致，年龄和细胞遗传学分层影响了该队列中的早期死亡。值得注意的是，革兰氏阴性菌定植、单核细胞性AML和CRP对早期死亡率也有显著影响。
