高白细胞急性髓系白血病早期死亡临床分析
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摘要
目的:探讨高白细胞急性髓系白血病(HAML)早期死亡的原因,分析其潜在危险因素。方法:回顾性分析67例初诊HAML患者(非M3型)在确诊后7d内早期死亡的病例(15例)和非早期死亡病例(52例)的临床特征。结果:15例(22.4%)早期死亡,原因分别为颅内出血(10例)、心力衰竭(2例)、肺栓塞(1例)、重度肺部感染(1例)及呼吸衰竭(1例)。早期死亡组白细胞淤滞分级评分(LGS)≥2分、外周血白细胞数、乳酸脱氢酶(LDH)及凝血功能异常发生率均高于非早期死亡组(P<0.05)。2组之间性别、年龄、初诊时外周血血红蛋白水平、血小板水平、骨髓原/幼细胞比例、法美英(FAB)分型、尿酸、肌酐的差异不明显(P>0.05)。Logistic回归分析表明,LDH为HAML患者早期死亡的危险因素。结论:白细胞淤滞、出血、脏器衰竭和感染是HAML早期死亡的主要原因。血LDH水平是HAML患者是否发生早期死亡的危险因素。
Objective: To investigate the high risk factors related to early death(ED) of newly diagnosed hyperleukocytic acute myeloid leukemia(HAML). Methods: The clinical data of 67 patients with newly diagnosed HAML(non M3) were analyzed. Clinical and laboratory features of patients with ED(15 cases) and non-ED(52 cases) were comparatively evaluated. Results: ED occurred in 15 patients(22.4%). Causes of ED included intracranial hemorrhage(10 cases), heart failure(2 cases), pulmonary embolism(1 case), severe pulmonary infection(1 case), and respiratory failure(1 case). As compared with the non-ED group, the incidence of higher LGS(≥2), greater white blood cell count, higher LDH, and abnormal blood coagulation was significantly increased in ED group(P<0.05). There was no statistically significant difference in gender, age, hemoglobin level, platelet count, percentage of blasts, FAB subtypes, uric acid level and creatinine level between two groups(P>0.05). Logistic regression analysis showed that LDH was the risk factor for ED in newly diagnosed HAML. Conclusion: The major causes of ED in HAML include severe bleeding, leukostasis, organs failure and severe infection. LDH is the risk factor for ED in newly diagnosed HAML.
Objective: To investigate the high risk factors related to early death(ED) of newly diagnosed hyperleukocytic acute myeloid leukemia(HAML). Methods: The clinical data of 67 patients with newly diagnosed HAML(non M3) were analyzed. Clinical and laboratory features of patients with ED(15 cases) and non-ED(52 cases) were comparatively evaluated. Results: ED occurred in 15 patients(22.4%). Causes of ED included intracranial hemorrhage(10 cases), heart failure(2 cases), pulmonary embolism(1 case), severe pulmonary infection(1 case), and respiratory failure(1 case). As compared with the non-ED group, the incidence of higher LGS(≥2), greater white blood cell count, higher LDH, and abnormal blood coagulation was significantly increased in ED group(P<0.05). There was no statistically significant difference in gender, age, hemoglobin level, platelet count, percentage of blasts, FAB subtypes, uric acid level and creatinine level between two groups(P>0.05). Logistic regression analysis showed that LDH was the risk factor for ED in newly diagnosed HAML. Conclusion: The major causes of ED in HAML include severe bleeding, leukostasis, organs failure and severe infection. LDH is the risk factor for ED in newly diagnosed HAML.
引文
1 沈悌,赵永强.血液病诊断及疗效标准[M].第4版.北京:科学出版社,2018:97-110.
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3 王敏,王立茹.高白细胞白血病研究现状[J].中国实用内科杂志,2011,31(4):298-300.
4 Marbello L,Ricci F,Nosari AM,et al.Outcome of hyperleukocytic adult acute myeloid leukaemia:a single-center retrospective study and review of literature [J].Leuk Res,2008,32(8):1221-1227.
5 Giammarco S,Chiusolo P,Piccirillo N,et al.Hyperleukocytosis and leukostasis:management of a medical emergency [J].Expert Rev Hematol,2017,10(2):147-154.
6 Ali AM,Mirrakhimov AE,Abboud CN,et al.Leukostasis in adult acute hyperleukocytic leukemia:a clinician's digest [J].Hematol Oncol,2016,34(2):69-78.
7 李天乐,江雪杰,王治香,等.高白细胞急性髓系白血病100例早期合并症分析及其干预方法优化[J].实用医学杂志,2013,29(15):2537-2539.
8 孟广强,陈以娟,张晶晶,等.白细胞淤滞分级评分在高白细胞急性髓系白血病降白细胞治疗效果评估中的应用[J].白血病·淋巴瘤,2015,24(12):729-731.
9 Piccirillo N,Laurenti L,Chiusolo P,et al.Reliability of leukostasis grading score to identify patients with high-risk hyperleukocytosis [J].Hematol,2009,84(6):381-382.
10 Porcu P,Cripe LD,Ng EW,et al.Hyperleukocytic leukemias and leukostasis:a review of pathophysiology,clinical presentation and management [J].Leuk Lymphoma,2000,39(1-2):1-18.
11 Djunic I,Virijevic M,Djurasinovic V,et al.Prognostic significance of CD56 antigen expression in patients with acute myeloid leukemia [J].Med Oncol,2012,29(3):2077-2082.
12 Malkan UY,Gunes G,Eliacik E,et al.The factors affecting early death after the initial therapy of acute myeloid leukemia [J].Int J Clin Exp Med,2015,8(12):22564-22569.
2 Novotny JR,Müller-Beissenhirtz H,Herget-Rosenthal S,et al.Grading of symptoms in hyperleukocytic leukemia:a clinical model for the role of different blast types and promyelocytes in the development of leukostasis syndrome [J].Haematol,2005,74(6):501-510.
3 王敏,王立茹.高白细胞白血病研究现状[J].中国实用内科杂志,2011,31(4):298-300.
4 Marbello L,Ricci F,Nosari AM,et al.Outcome of hyperleukocytic adult acute myeloid leukaemia:a single-center retrospective study and review of literature [J].Leuk Res,2008,32(8):1221-1227.
5 Giammarco S,Chiusolo P,Piccirillo N,et al.Hyperleukocytosis and leukostasis:management of a medical emergency [J].Expert Rev Hematol,2017,10(2):147-154.
6 Ali AM,Mirrakhimov AE,Abboud CN,et al.Leukostasis in adult acute hyperleukocytic leukemia:a clinician's digest [J].Hematol Oncol,2016,34(2):69-78.
7 李天乐,江雪杰,王治香,等.高白细胞急性髓系白血病100例早期合并症分析及其干预方法优化[J].实用医学杂志,2013,29(15):2537-2539.
8 孟广强,陈以娟,张晶晶,等.白细胞淤滞分级评分在高白细胞急性髓系白血病降白细胞治疗效果评估中的应用[J].白血病·淋巴瘤,2015,24(12):729-731.
9 Piccirillo N,Laurenti L,Chiusolo P,et al.Reliability of leukostasis grading score to identify patients with high-risk hyperleukocytosis [J].Hematol,2009,84(6):381-382.
10 Porcu P,Cripe LD,Ng EW,et al.Hyperleukocytic leukemias and leukostasis:a review of pathophysiology,clinical presentation and management [J].Leuk Lymphoma,2000,39(1-2):1-18.
11 Djunic I,Virijevic M,Djurasinovic V,et al.Prognostic significance of CD56 antigen expression in patients with acute myeloid leukemia [J].Med Oncol,2012,29(3):2077-2082.
12 Malkan UY,Gunes G,Eliacik E,et al.The factors affecting early death after the initial therapy of acute myeloid leukemia [J].Int J Clin Exp Med,2015,8(12):22564-22569.