目的:筛选预测初发高危急性早幼粒细胞白血病(acute promyelocytic leukemia,APL)发生分化综合征的因素,比较翻倍白细胞(WBCDouble)与峰值白细胞(WBCPeak)的预测价值.方法:回顾性分析我院血液科收治的78例经亚砷酸诱导治疗的初诊高危APL患者的临床特征,比较WBCDouble和WBCPeak分化综合征的分化程度.结果:分化综合征的发生率为57.69％(45/78),分化综合征最常见的临床症状为发热,重度分化综合征组发热、肺部浸润、心包积液发生率明显高于轻度分化综合征组,差异有统计学意义(P＜0.05).高危APL患者分化综合征的发生与化疗后 WBCPeak(45.21 ×109/L vs 25.24×109/L,P＜0.001)和化疗后 WBCDouble(37.59×109/L vs 17.46 × 109/L,P=0.007)有关.与WBCPeak组比较,WBCDouble组早于分化事件的发生率高(68.57％vs 40.00％,P=0.016),2组间重度分化、轻度分化和未分化差异均有统计学意义(P=0.002);WBCPeak组出现4个以上分化综合征症状的患者比例更多(28.57％vs 5.71％,P=0.012).与WBCNO-Double组比较,WBCDouble 组患者诊断时白细胞计数(P=0.003)、谷丙转氨酶(P=0.040)、外周血早幼粒细胞数(P=0.047)差异有统计学意义.结论:化疗后WBCDouble和化疗后WBCPeak是分化综合征的危险因素,化疗后WBCDouble较WBCPeak提示分化综合征的发生更有优势.
Comparative analysis of WBCDouble and WBCPeak in predicting differentiation syndrome during the single agent arsenic trioxide treatment of initial high-risk acute promyelocytic leukemia
Objective:To screen out the factors that predict the development of differentiation syndrome in new-onset high-risk acute promyelocytic leukemia(APL),and to compare the predictive value of WBCmuble and WBCPeak.Methods:The clinical characteristics of 78 newly diagnosed high-risk APL patients treated with arseni-ous acid as induction therapy were retrospectively analyzed.The differentiation extent of WBCDouble and WBCPeak differentiation syndrome were compared.Results:The incidence of differentiation syndrome was 57.69％(45/78).The most common symptom of differentiation syndrome was fever.The incidence of fever,pulmonary infil-tration and pericardial effusion in the severe differentiation syndrome group was significantly higher than that in the mild differentiation syndrome group,and there was significant difference(P＜0.05).The development of dif-ferentiation syndrome in high-risk APL patients was related to WBCPeak(45.21 × 109/L vs 25.24×109/L,P＜0.001)and WBCDouble(37.59 × 109/L vs 17.46 × 109/L,P=0.007)after chemotherapy.Compared with the WBCPeak group,the incidence of early differentiation events in the WBCDouble group was higher(68.57％vs 40.00％,P=0.016).There were significant differences in severe differentiation,mild differentiation and undif-ferentiated between the two groups(P=0.002).The WBCPeak group had more than 4 differentiation syndrome symptoms(28.57％vs 5.71％,P=0.012).Compared with the WBCNO-Double group,the white blood cell count(P=0.003),alanine aminotransferase level(P=0.040),and peripheral blood promyelocyte count(P=0.047)at diagnosis in the WBCDouble group were significantly different.Conclusion:WBCDouble after chemotherapy and WBCPeak after chemotherapy are risk factors for differentiation syndrome.WBCDouble after chemotherapy can better reflect the development of differentiation syndrome than WBCPeak.
differentiation syndromehigh-risk acute promyelocytic leukemiaWBCDouble after chemotherapyWBCPeak after chemotherapy
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