López-Jimenez J, Cancelas J A, García-Laraña J, Sastre J L, Cerveró C, Zamora C, Megido M, Hernández-Jodra M, Lasa E, Pérez-Oteyza J
Department of Hematology, Hospital Ramón y Cajal, Universidad de Alcalá de Henares, Madrid, Spain.
Transfusion. 1995 Apr;35(4):313-8. doi: 10.1046/j.1537-2995.1995.35495216080.x.
The purpose of this study was to evaluate 1) the incidence of hepatitis and its influence on the clinical management of and outcome in acute nonlymphoblastic leukemia (ANLL) patients in first complete remission and 2) the impact of routine hepatitis C virus screening on the incidence of hepatitis in these patients.
Clinical and blood bank charts were reviewed for 65 consecutive ANLL patients between 1985 and 1993 who achieved complete remission after a course of daunomycin and cytarabine (cytarabine: 200 mg/m2/day x 7 days in continuous infusion; daunomycin: 60 mg/m2/day for the first 3 days of the 7, as a bolus).
Only 43 percent of patients who developed hepatitis completed the scheduled therapy. Hepatitis did not decrease the probability of relapse (66 +/- 9% vs. 66 +/- 11%), but patients with changes in planned treatment, due to hepatitis or other causes, tended to have a higher relapse rate than patients without changes in consolidation therapy (56.5% vs. 40.4%; p = 0.10). This did not result in a decrease in disease-free survival, however, because of the higher number of treatment-related deaths in the patients without hepatitis (who completed the therapy). Over the period from 1985 through 1989, the 6-month actuarial probability of developing hepatitis was 42 percent. However, since 1989, when hepatitis C screening of blood donors was implemented, the incidence was reduced to 12.5 percent (p < 0.05), in spite of greater transfusion support (172 +/- 46 vs. 89 +/- 53, p < 0.01). No new cases of hepatitis were observed after the introduction of second-generation hepatitis C virus assays.
Hepatitis precludes the use of consolidation therapy in about half of ANLL patients, resulting, in the experience described here, in a trend toward a higher rate of relapse. Hepatitis C virus screening of blood components reduces the incidence of hepatitis in ANLL patients.
本研究的目的是评估1）肝炎的发生率及其对首次完全缓解的急性非淋巴细胞白血病（ANLL）患者临床管理和预后的影响，以及2）常规丙型肝炎病毒筛查对这些患者肝炎发生率的影响。
回顾了1985年至1993年间连续65例ANLL患者的临床和血库图表，这些患者在接受柔红霉素和阿糖胞苷治疗（阿糖胞苷：200mg/m²/天，持续输注7天；柔红霉素：在7天疗程的前3天，60mg/m²/天，静脉推注）后达到完全缓解。
发生肝炎的患者中只有43%完成了预定治疗。肝炎并未降低复发概率（66±9%对66±11%），但因肝炎或其他原因导致计划治疗改变的患者复发率往往高于巩固治疗未改变的患者（56.5%对40.4%；p=0.10）。然而，这并未导致无病生存率降低，因为无肝炎患者（完成治疗者）中与治疗相关的死亡人数较多。在1985年至1989年期间，发生肝炎的6个月精算概率为42%。然而，自1989年实施献血者丙型肝炎筛查以来，尽管输血支持增加（172±46对89±53，p<0.01），但发生率降至12.5%（p<0.05）。引入第二代丙型肝炎病毒检测后未观察到新的肝炎病例。
肝炎使约一半的ANLL患者无法进行巩固治疗，在此所述的经验中，导致复发率有升高趋势。对血液成分进行丙型肝炎病毒筛查可降低ANLL患者肝炎的发生率。
