Analysis of the follow-up results of 163 patients with acute promyelocytic leukemia

doi:10.3969/j.issn.1004-583X.2023.09.007

Abstract

Abstract:

Objective To explore the prognosis factors for patients with acute promyelocytic leukemia (APL). Methods Clinical data of 163 newly diagnosed APL patients in the Second Hospital of Anhui Medical University from January 2010 to December 2022 were retrospectively analyzed, including demographic data, hematological characteristics, treatment course, toxicity, complications, and prognosis. Results The median age of recruited patients was 35 (2-84) years. There were 13 (8.0%) cases of early death (ED), and 90.8% achieved a complete remission. There were 23 (14.1%) cases of additional chromosomal abnormalities (ACA) and 19 (11.7%) cases of FLT3-ITD mutation. Among them, 38 (23.3%), 74 (45.4%) and 51 (31.3%) were classified as low risk, intermediate risk, and high risk, respectively. A total of 78 (47.9%) cases were managed by a combination chemotherapy, including 29 cases in the high-risk group and 49 cases in the low-to-intermediate-risk group. The age of ED patients was significantly higher than that of non-ED group ( $P$ <0.01), and the proportion of ED in the high-risk group was significantly higher than that of other groups ( $P$ =0.001). The median follow-up time was 42.5 (0.1-156) months, with the 5-year progression-free survival (PFS) and 5-year overall survival (OS) of 73.3% and 79.5%, respectively, both of which did not reach the median PFS and OS. The univariate logistic regression analysis showed that age and treatment regimen significantly influenced PFS ( $P$ <0.01, and $P$ =0.053, respectively) and OS ( $P$ <0.01, and $P$ =0.021, respectively). Multivariate logistic regression analysis showed that age was the only risk factor for the PFS ( $P$ <0.01) and OS of APL ( $P$ <0.01). Treatment regimen was identified without a significant influence on the PFS ( $P$ =0.213) and OS ( $P$ =0.097). Conclusion Age and the classification of high risk are influencing factors for ED in APL patients. Age is an independent prognostic factor for the PFS and OS of APL. Reducing the chemotherapy cycles is proven feasible in high-risk APL patients.

Key words: acute promyelocytic leukemia, early death, age, chemotherapy

CLC Number:

R733.71

Dong Zhengrong, Tao Qianshan, Shen Yuanyuan, Dong Yi. Analysis of the follow-up results of 163 patients with acute promyelocytic leukemia[J]. Clinical Focus, 2023, 38(9): 813-818.

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URL: https://huicui.hebmu.edu.cn/EN/10.3969/j.issn.1004-583X.2023.09.007

https://huicui.hebmu.edu.cn/EN/Y2023/V38/I9/813

Figures/Tables 5

Tab. 1 Clinical characteristics of the patients

临床特征	数值
年龄(岁)	35(2~84)
性别[例(%)]
男	75(46.0)
女	88(54.0)
风险分层[例(%)]
低危	38(23.3)
中危	74(45.4)
高危	51(31.3)
早期死亡[例(%)]	14(8.6)
FLT3突变[例(%)]
有	19(11.7)
无	144(88.3)
ACA[例(%)]
有	23(14.1)
无	140(85.9)
联合化疗[例(%)]
是	78(47.9)
否	85(52.1)

Tab. 2 Clinical characteristics of early death patients

因素	早期死亡( $n$ =13)	非早期死亡( $n$ =150)	$P$ 值	统计值
年龄(岁)	61(27~84)	33(2~80)	<0.01	30.856
性别[例(%)]
男女	4(30.8) 9(69.2)	71(47.3) 79(52.7)	0.250	1.321
血红蛋白(g/L)	75(35~117)	80(32~143)	0.857	0.181
WBC(×10⁹/L)	21(0.53~116.94)	2.9(0.23~122)	0.004	2.855
PLT(×10⁹/L)	15(5~41)	20.5(1~134)	0.192	1.305
纤维蛋白(mg/dl)	0.85(0.52~5.68)	1.23(0.20~5.47)	0.128	1.522
PT(s)	15.9(11.4~30.8)	13.15(9.6~19.8)	0.086	1.719
APTT(s)	28.2(22.1~57.6)	27.85(16.5~48)	0.360	0.916
危险分层[例(%)]
低危	0(0)	38(25.3)
中危	3(23.1)	71(47.3)	0.001	14.246
高危	10(76.9)	41(27.3)
ACA[例(%)]
有无	0(0) 13(100)	23(14.1) 127(85.9)	0.268	1.228
FLT3突变[例(%)]
有无	2(15.4) 11(84.6)	17(11.3) 133(88.7)	0.663	0.435

Tab. 2 Clinical characteristics of early death patients

因素	早期死亡( $n$ =13)	非早期死亡( $n$ =150)	$P$ 值	统计值
年龄(岁)	61(27~84)	33(2~80)	<0.01	30.856
性别[例(%)]
男女	4(30.8) 9(69.2)	71(47.3) 79(52.7)	0.250	1.321
血红蛋白(g/L)	75(35~117)	80(32~143)	0.857	0.181
WBC(×10⁹/L)	21(0.53~116.94)	2.9(0.23~122)	0.004	2.855
PLT(×10⁹/L)	15(5~41)	20.5(1~134)	0.192	1.305
纤维蛋白(mg/dl)	0.85(0.52~5.68)	1.23(0.20~5.47)	0.128	1.522
PT(s)	15.9(11.4~30.8)	13.15(9.6~19.8)	0.086	1.719
APTT(s)	28.2(22.1~57.6)	27.85(16.5~48)	0.360	0.916
危险分层[例(%)]
低危	0(0)	38(25.3)
中危	3(23.1)	71(47.3)	0.001	14.246
高危	10(76.9)	41(27.3)
ACA[例(%)]
有无	0(0) 13(100)	23(14.1) 127(85.9)	0.268	1.228
FLT3突变[例(%)]
有无	2(15.4) 11(84.6)	17(11.3) 133(88.7)	0.663	0.435

Fig. 1 Progression-free survival of patients

Fig. 2 Overall survival of patients

Tab. 3 Univariable analysis of PFS and OS in APL patients

因素	例(%)	PFS		OS
因素	例(%)	χ²值	$P$ 值	χ²值	$P$ 值
年龄
≤60岁 >60岁	149(91.4) 14(8.6)	28.289	<0.01	29.296	<0.01
性别
男女	75(46.0) 88(54.0)	0.001	0.972	0.002	0.962
ACA
有无	23(14.1) 140(85.9)	0.194	0.659	0.258	0.611
FLT3突变
有无	19(11.7) 144(88.3)	0.587	0.444	0.392	0.531
危险分层
低危	38(23.3)
中危	74(45.4)	2.554	0.279	2.655	0.265
高危	51(31.3)
治疗方案
不联合化疗联合化疗	85(52.1) 78(47.9)	3.738	0.053	5.355	0.021

Tab. 3 Univariable analysis of PFS and OS in APL patients

因素	例(%)	PFS		OS
因素	例(%)	χ²值	$P$ 值	χ²值	$P$ 值
年龄
≤60岁 >60岁	149(91.4) 14(8.6)	28.289	<0.01	29.296	<0.01
性别
男女	75(46.0) 88(54.0)	0.001	0.972	0.002	0.962
ACA
有无	23(14.1) 140(85.9)	0.194	0.659	0.258	0.611
FLT3突变
有无	19(11.7) 144(88.3)	0.587	0.444	0.392	0.531
危险分层
低危	38(23.3)
中危	74(45.4)	2.554	0.279	2.655	0.265
高危	51(31.3)
治疗方案
不联合化疗联合化疗	85(52.1) 78(47.9)	3.738	0.053	5.355	0.021

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