Department of Medical Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India.
Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India.
Asian Pac J Cancer Prev. 2024 Sep 1;25(9):3229-3237. doi: 10.31557/APJCP.2024.25.9.3229.
To study the kinetics of blood count nadir and time to recovery and find its association with clinical outcomes in a cohort of Acute Lymphoblastic Leukemia (ALL).
Data from 243 cases treated between January 2018 to December 2020 was retrospectively analysed. Along with baseline data, serial measures of peripheral blood counts, nadir, and time to partial and complete recovery of counts during course of induction chemotherapy were recorded. Post-induction Complete Remission (CR) status, Event-Free Survival (EFS) , and Overall Survival (OS) were recorded as clinical outcomes for analysis.
Median age was 15 (range,1-62) years. Immunophenotype was B-ALL in 71% (n=172), and T-ALL in 27% (n=66). Good steroid response (D8) was seen in 89%(n=216), CR in 79% (n=192), and induction mortality in 12% (n=29). Median neutrophil nadir was 0.06(0-0.49) *10⁹/L and median day to nadir was D17. Median time to partial and complete platelet recovery was D18 and D25. Late neutrophil nadir (>D15) was independent predictor of refractory disease post-induction [OR=5.43 (95%CI 1.06-27.75)]. Late partial platelet recovery (>D22) was independent predictor of poorer EFS and OS [HR = 1.63 (95%CI 1.07-2.47)] and [HR = 1.5 (95% CI 1-2.4)] respectively.
We found that a longer time to neutrophil nadir independently predicts refractory disease post-induction and late partial platelet recovery is an independent factor for poorer EFS and OS. Thus, Blood count kinetics as independent predictors of induction outcomes can provide a simple, easy-to-use tool for balancing toxicity-efficacy during induction therapy for ALL.
研究急性淋巴细胞白血病（ALL）患者血液计数最低点及其恢复时间的动力学，并探讨其与临床结局的关系。
回顾性分析 2018 年 1 月至 2020 年 12 月期间治疗的 243 例患者的数据。除了基线数据外，还记录了诱导化疗过程中外周血计数的连续测量值、最低点以及计数部分和完全恢复的时间。诱导后完全缓解（CR）状态、无事件生存（EFS）和总生存（OS）被记录为分析的临床结局。
中位年龄为 15 岁（范围 1-62 岁）。免疫表型为 B-ALL 占 71%（n=172），T-ALL 占 27%（n=66）。89%（n=216）的患者对类固醇有良好的反应（D8），79%（n=192）的患者达到 CR，12%（n=29）的患者诱导死亡。中性粒细胞最低点中位数为 0.06（0-0.49）*10⁹/L，最低点时间中位数为 D17。血小板部分和完全恢复的中位数时间分别为 D18 和 D25。诱导后晚期中性粒细胞最低点（>D15）是难治性疾病的独立预测因素[比值比（OR）=5.43（95%可信区间 1.06-27.75）]。晚期血小板部分恢复（>D22）是 EFS 和 OS 较差的独立预测因素[风险比（HR）=1.63（95%可信区间 1.07-2.47）]和[HR=1.5（95%可信区间 1-2.4）]。
我们发现，中性粒细胞最低点的时间延长独立预测诱导后难治性疾病，晚期血小板部分恢复是 EFS 和 OS 较差的独立因素。因此，作为诱导结局的独立预测因素的血液计数动力学为 ALL 诱导治疗期间平衡毒性-疗效提供了一种简单易用的工具。
