Zhao Yanqiu, Yu Xinru, Yan Liru, Shi Deli, Li Jinqiao, Hou Wenyi, Zhang Qisheng, Zhu Yuxin, Zhang Yingmei
Department of Hematology, The First Affiliated Hospital of Harbin Medical University, Harbin, 150001, People's Republic of China.
Department of Developmental-Behavioral Pediatrics, The Sixth Affiliated Hospital of Harbin Medical University, Harbin, 150001, People's Republic of China.
Ann Hematol. 2025 Jan;104(1):183-192. doi: 10.1007/s00277-024-06165-1. Epub 2024 Dec 27.
This study aimed to analyze the baseline clinical characteristics, as well as the clinical features and risk factors of early death (ED) in older patients with acute promyelocytic leukemia (APL). A retrospective analysis was conducted on 198 consecutive older patients (age ≥ 50 years) with newly diagnosed APL who received arsenic trioxide alone as induction therapy, with 354 younger patients (age < 50 years) as controls. Ten easily obtainable clinical parameters were selected. Compared with the younger group, the older group had less fever, lower white blood cell (WBC) count, lower levels of albumin, and higher levels of creatinine upon admission. While the younger group had higher levels of aspartate aminotransferase and lower levels of fibrinogen (all P < 0.05). The ED rate was significantly higher in the older group (21.7% vs. 12.4%; P = 0.004). The causes of ED in the older group were bleeding, infection, embolism, differentiation syndrome, and others, in order of incidence. The cumulative incidence of ED due to infection (P = 0.0003) and embolism (P = 0.034) was significantly higher in the older group. For the older patients, independent risk factors for ED were WBC count > 5.9 × 10 /L, albumin < 35.85 g/L, creatinine > 72.9 µmol/L and fibrinogen < 1.137 g/L; independent risk factor for bleeding ED was WBC count > 6.2 × 10 /L; while independent risk factors for infection ED were albumin < 36.55 g/L and fibrinogen < 1.035 g/L. The baseline clinical characteristics, the clinical features and risk factors of ED in older APL patients were all quite different from those in younger patients, so research specifically targeting older patients with APL is very necessary.
本研究旨在分析老年急性早幼粒细胞白血病（APL）患者的基线临床特征，以及早期死亡（ED）的临床特征和危险因素。对198例连续的新诊断APL老年患者（年龄≥50岁）进行回顾性分析，这些患者接受三氧化二砷单药诱导治疗，并选取354例年轻患者（年龄<50岁）作为对照。选择了10个易于获得的临床参数。与年轻组相比，老年组入院时发热较少、白细胞（WBC）计数较低、白蛋白水平较低、肌酐水平较高。而年轻组天冬氨酸转氨酶水平较高、纤维蛋白原水平较低（均P<0.05）。老年组的ED发生率显著更高（21.7%对12.4%；P=0.004）。老年组ED的原因依次为出血、感染、栓塞、分化综合征等。老年组因感染（P=0.0003）和栓塞（P=0.034）导致的ED累积发生率显著更高。对于老年患者，ED的独立危险因素为WBC计数>5.9×10⁹/L、白蛋白<35.85g/L、肌酐>72.9µmol/L和纤维蛋白原<1.137g/L；出血性ED的独立危险因素为WBC计数>6.2×10⁹/L；而感染性ED的独立危险因素为白蛋白<36.55g/L和纤维蛋白原<1.035g/L。老年APL患者的基线临床特征、ED的临床特征和危险因素均与年轻患者有很大不同，因此针对老年APL患者的专门研究非常必要。
