Leukapheresis Does Not Improve Early Survival Outcome of Acute Myeloid Leukemia with Leukostasis Patients - A Dual-Center Retrospective Cohort Study.
Leukapheresis Does Not Improve Early Survival Outcome of Acute Myeloid Leukemia with Leukostasis Patients - A Dual-Center Retrospective Cohort Study.
复制标题
DOI：
10.2147/jbm.s312140
复制
发表时间：
2021
影响因子：
2
通讯作者：
Winston K
中科院分区：
文献类型：
--
作者：
Rinaldi I;Sari RM;Tedhy VU;Winston K
白细胞滞留是一种病死率较高的内科急症，常见于伴有高白细胞的急性髓系白血病患者。白细胞分离术是可用于急性髓系白血病止血的主要疗法之一。然而，与未接受白细胞分离的患者相比，白细胞分离是否能提供更好的生存益处仍不清楚。因此，我们的目标是评估化疗加白细胞分离联合治疗与单纯化疗对急性髓系白血病患者28天存活率的影响。这项研究是一项双中心回溯性队列研究，使用了2018年11月至2019年3月收集的医疗记录的二次数据。纳入标准为18岁或以上的成人患者，诊断为急性白血病，WBC计数大于100,000/ul定义为高白细胞状态，并有白细胞淤滞症状。采用Kaplan-Meier曲线法进行1个月生存分析。然后用COX比例风险模型进行单因素和多因素分析，得到风险比(HR)值，可信区间(CI)为95%。共获得38例患者进行分析。中位总生存期单纯化疗组为25天(95%CI：17.001~32.999天)，化疗加白细胞分离组为20天(95%CI：1.497~38.503天)。白细胞分离术对28天存活期(HR：1.140；95%CI：0.396~3.283；p值：0.809)和7天存活率(HR：1.073；95%CI：0.277~4.152；p值：0.919)无影响。在多因素分析中，年龄≥60岁、原始细胞百分比≥90%、肌酐≥1.4 mg/dL和弥散性血管内凝血与较差的28天生存相关。与仅接受化疗的AML患者相比，同时接受化疗和白细胞分离的AML患者的28天和7天的生存期并不是很好。高龄、高急变率、高肌酐和弥漫性血管内凝血是导致28天存活率较差的预后因素。
Leukostasis is a medical emergency with high mortality which often occurs in acute myeloid leukemia patients with hyperleukocytosis. One of the therapies that can be used for leukostasis in acute myeloid leukemia is leukapheresis. However, whether leukapheresis can provide better survival benefit when compared with patients not receiving leukapheresis is still unclear. Hence, we aimed to evaluate the effect of chemotherapy plus leukapheresis combination versus chemotherapy only on 28-day survival of acute myeloid leukemia patients with leukostasis. This study was a dual-center retrospective cohort using secondary data from medical records collected from November 2018 to March 2019. Inclusion criteria were adult patients aged 18 years old or above, diagnosed with acute leukemia with hyperleukocytosis status defined by WBC count greater than 100,000/uL, and with symptoms of leukostasis. One-month survival analysis was conducted using Kaplan–Meier curve method. Univariate and multivariate analyses were then conducted using Cox proportional hazards model to obtain value of hazard ratio (HR) with a 95% confidence interval (CI). A total of 38 patients were obtained for analysis. The median overall survival was 25 days (95% CI: 17.001–32.999 days) in the chemotherapy only group and 20 days (95% CI: 1.497–38.503) in the chemotherapy with leukapheresis group. The use of leukapheresis did not affect 28-day survival (HR: 1.140; 95% CI: 0.396–3.283; p value: 0.809) and 7-day survival (HR: 1.073; 95% CI: 0.277–4.152; p value: 0.919). In the multivariate analysis, age ≥60 years, blast percentage ≥90%, creatinine ≥1.4 mg/dL, and presence of disseminated intravascular coagulation were associated with worse 28-day survival. AML patients with leukostasis who received both chemotherapy and leukapheresis did not have better 28-day survival and 7-day survival when compared with patients receiving chemotherapy only. Old age, high blast percentage, high creatinine, and presence of disseminated intravascular coagulation were prognostic factors for worse 28-day survival.