Favre G, Fopp M, Gmür J, Tichelli A, Fey M F, Tobler A, Schatzmann E, Gratwohl A
Kantonsspital Basel, Switzerland.
Ann Hematol. 1993 Oct;67(4):153-60. doi: 10.1007/BF01695861.
Supportive care is a prerequisite for intensive chemotherapy in leukemic patients. Little has been published about quantitative aspects of red blood cell and platelet transfusions. We evaluated transfusion requirements and factors associated with observed differences in 206 patients undergoing initial induction consolidation chemotherapy for newly diagnosed acute myelogenous leukemia. All patients were treated during a 5-year period in 12 hospitals on a common protocol of the Swiss Study Group for Clinical Cancer Research (SAKK). Protocol 30/85 comprises a double induction and one course of consolidation. Of 206 registered patients, 199 were evaluable; 118 of 199 (59%) patients entered completed all three cycles of chemotherapy. These 118 patients received a median (range) of 18 (3-44) units of red blood cells and 12 (2-61) platelet transfusions during 112 (70-129) days of hospitalization. Patients with a hemoglobin > 10 g/l, platelets > 100 x 10(9)/l, and white blood cell counts < 5 x 10(9)/l at diagnosis received fewer transfusions than patients with less favorable blood counts during the first cycle of chemotherapy (p < 0.05). Patients with FAB subtype M3 received more platelet transfusions during the first cycle. Female patients received more platelet transfusions than male patients. In multivariate analyses the participating center was the most important single factor associated with the number of red cell and platelet concentrates given per patient and cycle (p < 0.05), the number of days in hospital (p < 0.05), and the risk of premature withdrawal from the study. These data define factors associated with transfusion requirements in patients treated for newly diagnosed AML. They include severity and subtype of disease at diagnosis, age and sex of the patients, and the participating institution. Results suggest that medical decision-making varies from center to center. The participating institution is strongly associated with differences in transfusion requirements, hospitalization time, and premature withdrawal from study. Leukemia trials tend to focus on the prospective evaluation of chemotherapy or growth factors. Our results suggest that other variables, such as management strategies, should be included for prospective analysis.
支持性护理是白血病患者强化化疗的前提条件。关于红细胞和血小板输注的定量方面，相关文献报道较少。我们评估了206例新诊断急性髓系白血病患者在接受初始诱导巩固化疗时的输血需求及与观察到的差异相关的因素。所有患者均在5年期间内于12家医院按照瑞士临床癌症研究组（SAKK）的通用方案接受治疗。方案30/85包括两次诱导和一个巩固疗程。在206例登记患者中，199例可评估；199例中的118例（59%）患者完成了所有三个化疗周期。这118例患者在112天（70 - 129天）的住院期间接受红细胞输注的中位数（范围）为18（3 - 44）单位，血小板输注的中位数（范围）为12（2 - 61）单位。诊断时血红蛋白>10 g/l、血小板>100×10⁹/l且白细胞计数<5×10⁹/l的患者在化疗第一个周期接受的输血次数少于血液指标较差的患者（p<0.05）。FAB亚型M3的患者在第一个周期接受的血小板输注更多。女性患者接受的血小板输注比男性患者多。在多变量分析中，参与中心是与每位患者每个周期给予的红细胞和血小板浓缩物数量（p<0.05）、住院天数（p<0.05）以及提前退出研究风险相关的最重要单一因素。这些数据确定了新诊断急性髓系白血病患者输血需求相关的因素。它们包括诊断时疾病的严重程度和亚型、患者的年龄和性别以及参与机构。结果表明，医疗决策因中心而异。参与机构与输血需求、住院时间和提前退出研究的差异密切相关。白血病试验往往侧重于化疗或生长因子的前瞻性评估。我们的结果表明，其他变量，如管理策略，应纳入前瞻性分析。
