基线血液计数水平增加肯尼亚 CML 患者发生细胞减少症的几率：一项病例对照研究。

Baseline blood count levels increase odds of cytopenia among CML patients in Kenya: a case control study.

机构信息

Department of Internal Medicine and therapeutics, Kenyatta University, Nairobi, Kenya.

Department of Human Pathology, School of Medicine, Unit of Hematology and Blood Transfusion, University of Nairobi, Nairobi, Kenya.

出版信息

BMC Cancer. 2022 Feb 1;22(1):128. doi: 10.1186/s12885-021-09162-z.

DOI:10.1186/s12885-021-09162-z

PMID:35105321

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8805406/

Abstract

BACKGROUND

Imatinib is the gold standard for the treatment of all phases of Philadelphia positive Chronic Myeloid Leukemia (CML). During treatment, patients may develop cytopenia. We aimed to study the baseline characteristics and factors associated with cytopenia at a Nairobi Hospital.

METHODS

This was a retrospective case-control study of patients aged ≥18 years on follow-up at the Glivec International Patient Access Program (GIPAP) clinic from 2007 to 2015. The cases consisted of CML patients on imatinib who developed cytopenia. The controls were CML patients on imatinib who did not develop cytopenia. Baseline socio - demographic, clinical, hematologic, and molecular data were retrieved from patients' files. Chi square or fishers' exact tests were used to analyze for differences between cytopenia and no cytopenia. Binary logistic regressions were employed to identify relationships. Univariate and multivariate analyses were done to identify independent predictors of cytopenia. Odds ratios (OR) were presented including the 95% confidence intervals and respective p values.

RESULTS

A total of 201 patients were studied consisting of ninety-four (94) patients with cytopenia and 107 with no cytopenia. Among the entire population, males were 52, and 42% were aged 36-50 years. Sex, age, marital status, occupation and education level were similar between the cytopenia and no cytopenia groups. Among the 201 patients, 70% had symptoms for > 12 months before diagnosis, 78.6% had B symptoms at baseline, 80% had a moderate splenomegaly at baseline. Among patients with cytopenia, 40 and 37.4% developed cytopenia within 3 months and 3-6 months respectively after imatinib initiation. Baseline neutrophilia, neutropenia, anaemia, thrombocytosis, thrombocytopenia was found in 68, 11, 11, 23.5 and 11% respectively. Baseline hemoglobin, neutrophil and platelet level were significantly different between the cytopenia and the no cytopenia group. On univariable analysis, baseline anemia with hb < 7.9 g/dL (p = 0.002), neutropenia (p = 0.001), neutrophilia > 100,000/mm (p = 0.002) and thrombocytopenia (p = 0.001) increased the odds of developing cytopenia. On multivariable analysis, baseline anaemia (p value < 0.002), neutropenia (p value < 0.001), thrombocytopenia (p value, < 0.001) and thrombocytosis (p value, 0.033) increased the odds of developing cytopenia.

CONCLUSION

Odds of cytopenia were higher in presence of baseline cytopenia and thrombocytosis. Clinicians should have a high index of suspicion for these patients.

摘要

背景

伊马替尼是治疗费城阳性慢性髓性白血病（CML）所有阶段的金标准。在治疗过程中，患者可能会出现细胞减少症。我们旨在研究内罗毕医院的基线特征和与细胞减少症相关的因素。

方法

这是一项回顾性病例对照研究，纳入了 2007 年至 2015 年期间在 Glivec 国际患者准入计划（GIPAP）诊所接受随访的年龄≥18 岁的患者。病例组为接受伊马替尼治疗且出现细胞减少症的 CML 患者。对照组为接受伊马替尼治疗且未发生细胞减少症的 CML 患者。从患者档案中检索基线社会人口统计学、临床、血液学和分子数据。使用卡方检验或 Fisher 精确检验分析细胞减少症与无细胞减少症之间的差异。采用二元逻辑回归分析确定关系。进行单变量和多变量分析，以确定细胞减少症的独立预测因素。给出了优势比（OR），包括 95%置信区间和相应的 P 值。

结果

共研究了 201 名患者，其中 94 名患者出现细胞减少症，107 名患者无细胞减少症。在整个人群中，男性为 52 人，42%年龄在 36-50 岁之间。细胞减少症和无细胞减少症组之间的性别、年龄、婚姻状况、职业和教育水平相似。在 201 名患者中，70%在诊断前有>12 个月的症状，78.6%在基线时有 B 症状，80%在基线时有中度脾肿大。在出现细胞减少症的患者中，分别有 40%和 37.4%在伊马替尼治疗开始后 3 个月和 3-6 个月内出现细胞减少症。基线中性粒细胞增多、中性粒细胞减少症、贫血、血小板增多、血小板减少症分别为 68%、11%、11%、23.5%和 11%。细胞减少症组和无细胞减少症组之间的基线血红蛋白、中性粒细胞和血小板水平存在显著差异。单变量分析显示，基线贫血伴 Hb<7.9 g/dL（p=0.002）、中性粒细胞减少症（p=0.001）、中性粒细胞>100,000/mm（p=0.002）和血小板减少症（p=0.001）增加了发生细胞减少症的几率。多变量分析显示，基线贫血（p 值<0.002）、中性粒细胞减少症（p 值<0.001）、血小板减少症（p 值<0.001）和血小板增多症（p 值=0.033）增加了发生细胞减少症的几率。