Qiu Kunyin, Liao Xiongyu, Li Yang, Huang Ke, Xu Honggui, Fang Jianpei, Zhou Dunhua
Department of Hematology/Oncology, Children's Medical Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China.
Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China.
Cancers (Basel). 2023 Sep 7;15(18):4462. doi: 10.3390/cancers15184462.
: To determine associations between allogeneic blood transfusion (ABT) during the intensive induction phase of therapy and prognostic effect in a real-world cohort of pediatric patients with acute lymphoblastic leukemia (ALL). : A total of 749 pediatric patients who were diagnosed with ALL were enrolled in this study by using a single-center retrospective cohort study method from February 2008 to May 2022. : Among the ABT patients, 711 (94.9%) children were transfused with packed red blood cells (PRBCs), 434 (57.9%) with single-donor platelets (SDPs), and 196 (26.2%) with fresh frozen plasma (FFP). Our multivariate analysis demonstrated that FFP transfusion was the unique independent factor that affected both relapse-free survival (RFS) and overall survival (OS). The transfusion of FFP was significantly associated with higher age ( < 0.001), being more likely to receive SCCLG-ALL-2016 protocol ( < 0.001), higher proportion of more than 25 blood product transfusions, more PRBC transfusion ( < 0.001), and higher D33-MRD-positive rates ( = 0.013). Generalized additive models and threshold effect analysis using piece-wise linear regression were applied to identify the cut-off value of 25 mL/kg for average FFP transfusion. K-M survival analysis further confirmed that average FFP transfusion > 25 mL/kg was an independent adverse indicator of inferior outcome in terms of RFS ( = 0.027) and OS ( = 0.033). : In blood products, only FFP supplement is closely related to the prognosis of childhood ALL. During the intensive induction phase, the indications of FFP transfusion should be strictly grasped, and the total amount of FFP should be controlled and kept below 25 mL/kg.
为确定急性淋巴细胞白血病（ALL）患儿真实世界队列中强化诱导治疗阶段的异体输血（ABT）与预后效果之间的关联。采用单中心回顾性队列研究方法，纳入2008年2月至2022年5月期间诊断为ALL的749例儿科患者。在接受ABT的患者中，711例（94.9%）儿童输注了浓缩红细胞（PRBC），434例（57.9%）输注了单供者血小板（SDP），196例（26.2%）输注了新鲜冰冻血浆（FFP）。我们的多变量分析表明，FFP输血是影响无复发生存期（RFS）和总生存期（OS）的唯一独立因素。FFP输血与较高年龄显著相关（<0.001），更有可能接受SCCLG-ALL-2016方案（<0.001），超过25次血液制品输血的比例更高，更多的PRBC输血（<0.001），以及更高的D33微小残留病（MRD）阳性率（=0.013）。应用广义相加模型和使用分段线性回归的阈值效应分析来确定平均FFP输血的25 mL/kg临界值。K-M生存分析进一步证实，平均FFP输血>25 mL/kg是RFS（=0.027）和OS（=0.033）方面预后较差的独立不良指标。在血液制品中，只有FFP补充与儿童ALL的预后密切相关。在强化诱导阶段，应严格掌握FFP输血的指征，控制FFP总量并使其保持在25 mL/kg以下。
