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急性髓系白血病患者在强化化疗期间发生血栓形成对长期生存无影响。

The occurrence of thrombosis during intensive chemotherapy treatment for acute myeloid leukemia patients does not impact on long-term survival.

作者信息

Hellou Tamer, Cohen Omri, Avigdor Abraham, Amitai Irina, Shimoni Avichai, Misgav Mudi, Canaani Jonathan

机构信息

Hematology Division, Sheba Medical Center, Faculty of Medicine, Tel Aviv University, 52621, Tel-Hashomer, Israel.

Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

出版信息

Ann Hematol. 2023 May;102(5):1037-1043. doi: 10.1007/s00277-023-05158-w. Epub 2023 Mar 11.

Abstract

Venous thromboembolism (VTE) is frequently seen in acute myeloid leukemia (AML) patients and presents a significant clinical challenge. The association of VTE during intensive chemotherapy with risk models such as the Medical Research Council (MRC) cytogenetic-based assessment and the European LeukemiaNet (ELN) 2017 molecular risk model have not been rigorously evaluated. Additionally, there is a paucity of data pertaining to the long-term prognostic impact of VTE in AML patients. We performed an analysis of baseline parameters of AML patients diagnosed with VTE during intensive chemotherapy and compared them with patients without VTE. The analyzed cohort consisted of 335 newly diagnosed AML patients with a median age of 55 years. Thirty-five patients (11%) were classified as MRC favorable risk, 219 (66%) patients as intermediate risk, 58 patients (17%) as adverse risk. Per ELN 2017, 132 patients (40%) had favorable risk disease, 122 patients (36%) intermediate risk, and 80 patients (24%) had adverse risk. VTE was seen in 33 patients (9.9%), occurring mostly during induction (70%), and required catheter removal in 9 patients (28%). Baseline clinical, laboratory, molecular, and ELN 2017 parameters were not significantly different groups. However, MRC intermediate-risk group patients were significantly more likely to experience thrombosis compared to favorable risk and adverse risk patients (12.8% versus 5.7% and 1.7%, respectively; p = 0.049). Median overall survival was not significantly impacted by the diagnosis of thrombosis (3.7 years versus 2.2 years; p = 0.47). VTE is tightly associated with temporal and cytogenetic parameters in AML but does not significantly impact on long-term outcomes.

摘要

静脉血栓栓塞症(VTE)在急性髓系白血病(AML)患者中很常见,是一项重大的临床挑战。强化化疗期间VTE与诸如医学研究委员会(MRC)基于细胞遗传学的评估和欧洲白血病网(ELN)2017分子风险模型等风险模型之间的关联尚未得到严格评估。此外,关于VTE对AML患者长期预后影响的数据也很匮乏。我们对强化化疗期间诊断为VTE的AML患者的基线参数进行了分析,并将其与无VTE的患者进行比较。分析队列包括335例新诊断的AML患者,中位年龄为55岁。35例患者(11%)被归类为MRC低危,219例患者(66%)为中危,58例患者(17%)为高危。根据ELN 2017标准,132例患者(40%)患有低危疾病,122例患者(36%)为中危,80例患者(24%)为高危。33例患者(9.9%)出现VTE,大多发生在诱导期(70%),9例患者(28%)需要拔除导管。基线临床、实验室、分子和ELN 2017参数在各组之间无显著差异。然而,与低危和高危患者相比,MRC中危组患者发生血栓形成的可能性显著更高(分别为12.8%、5.7%和1.7%;p = 0.049)。血栓形成的诊断对中位总生存期没有显著影响(3.7年对2.2年;p = 0.47)。VTE与AML的时间和细胞遗传学参数密切相关,但对长期预后没有显著影响。

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