Shandong Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.
Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, Shandong, China.
BMC Cancer. 2022 May 1;22(1):477. doi: 10.1186/s12885-022-09601-5.
Platelet counts varied over time after induction chemotherapy. We aimed to investigate the different trajectories of platelet counts after the first cycle of induction chemotherapy in patients newly diagnosed with acute myeloid leukemia.
In total, 149 individuals were included in this study. We identified four distinct trajectories using a group-based trajectory model: low- stability group (n = 27, 18.12%), low-level decrease-medium elevation group (n = 42, 28.19%), low-level decrease-high elevation group (n = 60, 40.27%), and high-level decrease-medium elevation group (n = 20, 13.42%). The baseline characteristics of the high-level decrease-medium elevation group included higher platelet count, lower white blood cell count, lower percentage of bone marrow blasts, and lower rates of complete remission after the first cycle of induction chemotherapy. Compared with the low-stability group, the hazard ratios were 0.32 (95% confidence interval, 0.15-0.68) for the low-level decrease-medium elevation group, 0.31 (95% confidence interval, 0.15-0.63) for the low-level decrease-high elevation group, and 0.35 (95% confidence interval, 0.13-0.89) for the high-level decrease-medium elevation group after adjustment for age and gender by Cox proportional hazard regression. Compared with the low-stability group, the hazard ratios were 0.33 (95% confidence interval, 0.14-0.77) for the low-level decrease-medium elevation group and 0.31 (95% confidence interval, 0.14-0.67) for the low-level decrease-high elevation group after adjustment for age, gender, white blood cell count, and bone marrow blasts. These associations persisted after adjusting for age, gender, white blood cell count, bone marrow blasts, and platelet count.
The dynamic trajectory of platelet counts after the first cycle of induction chemotherapy is a significant predictor of all-cause mortality in patients with acute myeloid leukemia. Timely intervention should be considered for the low-stability group. The low-level decrease-medium elevation and low-level decrease-high elevation groups were independent protective factors for all-cause mortality.
诱导化疗后血小板计数随时间变化。我们旨在研究初诊急性髓系白血病患者诱导化疗第一周期后血小板计数的不同变化轨迹。
共纳入 149 例患者。我们使用基于群组的轨迹模型确定了四种不同的轨迹：低稳定性组（n=27，18.12%）、低水平降低-中高水平升高组（n=42，28.19%）、低水平降低-高水平升高组（n=60，40.27%）和高水平降低-中高水平升高组（n=20，13.42%）。高水平降低-中高水平升高组的基线特征包括血小板计数较高、白细胞计数较低、骨髓原始细胞比例较低、诱导化疗第一周期后完全缓解率较低。与低稳定性组相比，低水平降低-中高水平升高组的风险比为 0.32（95%置信区间，0.15-0.68），低水平降低-高水平升高组为 0.31（95%置信区间，0.15-0.63），高水平降低-中高水平升高组为 0.35（95%置信区间，0.13-0.89），这是通过 Cox 比例风险回归模型对年龄和性别进行调整后的结果。与低稳定性组相比，在调整年龄、性别、白细胞计数和骨髓原始细胞比例后，低水平降低-中高水平升高组和低水平降低-高水平升高组的风险比分别为 0.33（95%置信区间，0.14-0.77）和 0.31（95%置信区间，0.14-0.67）。这些关联在调整年龄、性别、白细胞计数、骨髓原始细胞比例和血小板计数后仍然存在。
诱导化疗第一周期后血小板计数的动态轨迹是急性髓系白血病患者全因死亡率的重要预测因素。对于低稳定性组应考虑及时干预。低水平降低-中高水平升高和低水平降低-高水平升高组是全因死亡率的独立保护因素。
