复发急性早幼粒细胞白血病患者早期死亡风险因素分析

Prognostic Factors for Early Death in Patients with Relapsed Acute Promyelocytic Leukemia Treated with Single-agent Arsenic Trioxide

目的本研究分析了接受亚砷酸(ATO)单药诱导治疗血液学复发的急性早幼粒细胞白血病(APL)患者早期死亡(ED)的发生率,病因和预后因素,以期为临床实践中患者入院后数小时内快速鉴别出ED高风险病例提供帮助。方法收集笔者医院近9年收治的96例连续接受单药ATO诱导治疗过程中发生血液学复发的APL患者临床及实验室资料,选择了11个临床参数作为候选ED风险因素进行单变量和多变量统计学分析。结果共有22例患者(22.9%)发生了ED,ED的最主要原因为出血,其次为分化综合征、感染和其他原因。男性、白细胞计数>10×10^9/L、D二聚体>4mg/L、血浆尿酸>正常和血浆肌酐>正常是复发APL患者ED的独立危险因素。结论本研究提供的临床相关信息可能会为复发APL患者设计风险适宜的治疗方案最终降低ED率提供帮助。

Objective To investigat the incidence,causes,and prognostic factors of early death (ED) in patients with hematologically relapsed acute promyelocytic leukemia (APL),who all received single-agent arsenic trioxide (ATO) as induction therapy,to help clinicians to rapid identify of patients at a high risk of ED within the first few hours of hospital admission.Methods The clinical data of 96 consecutive patients diagnosed as hematologically relapsed APL over a period of 9 years in our hospital were collected.All patients received single-agent ATO as induction therapy.Eleven clinical and laboratory parameters were chosen for univariate and multivariate statistical analysis.Results Totally 22 relapsed (22.9%) patients died within the first 30 days of induction treatment.Hemorrhage was the main cause of ED,followed by differentiation syndrome,infection,and other causes.Male sex,white blood cell count>10 × 10^9/L,D- dimer>4mg/L,elevated serum uric acid level and increased serum creatinine level were independent risk factors for ED in the relapsed patients.Conclusion These data furnish clinically relevant information that might be useful for designing more appropriate risk-adapted treatment protocols aimed at reducing ED rate in patients with relapsed APL.