Abstract
Purpose
Early death (ED) is the main cause of acute promyelocytic leukemia (APL) treatment failure, and the ED rate is higher for elderly patients than that for young ones. To date, no studies have been found focusing on ED in elderly patients with APL.
Methods
This study retrospectively analyzed the clinical data of 409 consecutive patients with APL (139 patients ≥ 50 years old, 270 patients < 50 years old). All patients received arsenic trioxide alone as induction therapy. The baseline clinical characteristics and ED occurrence and predictors between elderly and young patients with APL were compared and analyzed.
Results
The clinical features of elderly patients at admission were not significantly different from those of young ones. The ED rate of elderly patients was significantly greater than that of young patients (23.74% vs 11.85%, P = 0.0018). Hemorrhage is the main cause of ED in elderly patients, followed by infection and differentiation syndrome. From the 15th to 30th days of treatment, elderly patients had a higher mortality rate than that of young patients (7.83% vs 2.06%, P = 0.009). Male, white blood cell (WBC) count > 10 × 109/L, fibrinogen < 1.0 g/L and low albumin levels were independent risk factors for ED in elderly patients, while ED was only correlated with WBC count, fibrinogen and creatinine levels in young patients.
Conclusion
The results of this study may help design more rational treatment plans for elderly patients with APL based on early mortality risk to reduce the ED rate.
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Abbreviations
- APL:
-
Acute promyelocytic leukemia
- ED:
-
Early death
- ATO:
-
Arsenic trioxide
- FIB:
-
Fibrinogen
- WBC:
-
White blood cell
- PLT:
-
Platelet
- DD:
-
D-dimer
- AST:
-
Aspartate aminotransferase
- ALB:
-
Albumin
- Cr:
-
Creatinine
- UA:
-
Uric acid
- HR:
-
Hazard ratio
- CI:
-
Confidence interval
- DS:
-
Differentiation syndrome
- DIC:
-
Disseminated intravascular coagulation
- ATRA:
-
All-trans retinoic acid
- LDH:
-
Lactate dehydrogenase
- ECOG-PS:
-
Eastern Cooperative Oncology Group performance status
- CNS:
-
Central nervous system
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Funding
This work was supported by the National Natural Science Foundation of China (No. 81270589), and Natural Science Foundation of Heilongjiang Province (No. H2017032).
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BJ conceived, designed, analyzed the data, and wrote the manuscript. YZ conceived, designed, and participated in data analysis. JZ analyzed data and is the corresponding author. WH, FC and ML analyzed the data. HY, XT, YW, JH, JF and HL participated in data collection. All authors reviewed the manuscript. All authors read and approved the final manuscript.
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This study protocol was discussed and approved by the Medical Ethics Committee of the First Affiliated Hospital of Harbin Medical University who waived the need for patient informed consent for this retrospective analysis.
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Jin, B., Zhang, Y., Hou, W. et al. Comparative analysis of causes and predictors of early death in elderly and young patients with acute promyelocytic leukemia treated with arsenic trioxide. J Cancer Res Clin Oncol 146, 485–492 (2020). https://doi.org/10.1007/s00432-019-03076-x
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DOI: https://doi.org/10.1007/s00432-019-03076-x