资源受限情况下急性早幼粒细胞白血病分化诱导剂的转换-队列研究。

Shifting gears to differentiation agents in acute promyelocytic leukemia with resource constraints-a cohort study.

机构信息

Department of Hematology, All India Institute of Medical Sciences, New Delhi, India.

出版信息

Acta Oncol. 2022 Sep;61(9):1050-1055. doi: 10.1080/0284186X.2022.2109424. Epub 2022 Aug 11.

DOI:10.1080/0284186X.2022.2109424

PMID:35950607

Abstract

BACKGROUND

Treatment of acute promyelocytic leukaemia has emerged as a major success in hemato-oncology. While literature from the developed world boasts of outstanding outcomes, there is a paucity of data from the developing world. This study aimed to assess complications and outcomes of acute promyelocytic leukaemia in a resource-constrained setting.

METHODS

We retrospectively collected data from patients diagnosed with APL from January 2016 to December 2020.

RESULTS

Sixty-four patients were treated-32 in both the Sanz high and low-risk groups. In the Sanz low-risk group, 12.5% of patients received ATRA with daunorubicin and 81.25% received ATRA with ATO. In the Sanz high-risk group, 18.8% of patients received ATRA with daunorubicin, 34.3% received ATRA with daunorubicin and ATO while 40.6% received ATRA with ATO. 56.25% of patients developed differentiation syndrome. The incidence was higher in Sanz high-risk group as compared to Sanz low-risk group. 57.4% of patients had an infection at the time of presentation. 62.5% of patients developed neutropenic fever during treatment. 17.2% of patients developed pseudotumor cerebri. The 4-year EFS and OS were 71.25 and 73.13%, respectively. Sanz low-risk group had a better 4-year EFS and OS as compared to the Sanz high-risk group. Haemoglobin at presentation and Sanz high-risk group were associated with poorer outcomes with a hazard ratio of 0.8 and 3.1, respectively. Outcomes in high-risk patients were better with the use of ATRA + ATO + daunorubicin.

CONCLUSION

In the Indian population, APL patients have a high incidence of differentiation syndrome, pseudotumor cerebri, and infections during induction. CR, EFS, and OS compared to the developed world can be achieved with optimal therapy. Low haemoglobin at presentation and Sanz high-risk group were associated with poorer outcomes. ATRA, ATO, and daunorubicin combination is the preferred protocol for treating high-risk patients.

摘要

背景

急性早幼粒细胞白血病的治疗已成为血液肿瘤学的重大成就。虽然来自发达国家的文献报告了出色的结果，但发展中国家的数据却很少。本研究旨在评估资源有限环境下急性早幼粒细胞白血病的并发症和结局。

方法

我们回顾性地收集了 2016 年 1 月至 2020 年 12 月期间诊断为 APL 的患者的数据。

结果

共治疗了 64 名患者，其中 Sanz 低危组和高危组各 32 名。在 Sanz 低危组中，12.5%的患者接受 ATRA 联合柔红霉素治疗，81.25%的患者接受 ATRA 联合 ATO 治疗。在 Sanz 高危组中，18.8%的患者接受 ATRA 联合柔红霉素治疗，34.3%的患者接受 ATRA 联合柔红霉素和 ATO 治疗，40.6%的患者接受 ATRA 联合 ATO 治疗。56.25%的患者发生分化综合征。与 Sanz 低危组相比，Sanz 高危组的发生率更高。57.4%的患者在就诊时存在感染。62.5%的患者在治疗过程中发生中性粒细胞减少性发热。17.2%的患者发生假性脑瘤。4 年 EFS 和 OS 分别为 71.25%和 73.13%。与 Sanz 高危组相比，Sanz 低危组 4 年 EFS 和 OS 更好。就诊时的血红蛋白和 Sanz 高危组与较差的预后相关，风险比分别为 0.8 和 3.1。高危患者使用 ATRA+ATO+柔红霉素治疗可获得更好的结果。