急性髓系白血病从诊断到诱导时间重要吗?

IF 1.3 Q4 HEMATOLOGY
Journal of hematology Pub Date : 2025-07-08 eCollection Date: 2025-08-01 DOI:10.14740/jh2075
Osama Batayneh, Deevyashali Parekh, Margarita Vazquez Almonte, Cristina Hamacher, Angela Gupta, Danielle Passafiume, Michael Sandhu, Carina Hernandez, Safa Afridi, Sanjay Rao Gergal GopalakrishnaRao, Alyssa Cortese, Alexandra Goodman, Kelsey Christo, Josh Wallace, Teresa Gentile
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引用次数: 0

摘要

背景:虽然分子和细胞遗传学检测可以改变急性髓性白血病(AML)患者的预后和指导治疗强度,但另一方面,从诊断到治疗的时间(TDT)可能会影响治疗结果和生存。考虑到分子研究可能需要长达2周的时间才能得出结果,这些考虑有时会相互矛盾。方法:在纽约州立大学医院进行回顾性队列分析,研究TDT对完全缓解(CR)和总生存(OS)的影响。受试者至少18岁,诊断为AML,并在2010年1月至2024年6月期间接受治疗。TDT分为化疗诱导1 ~ 5天、6 ~ 10天、11天以上三种。采用单因素Kaplan-Myer生存分析和多因素Cox回归模型。结果:共纳入187例患者,其中34% (n = 64)年龄小于60岁。其中,20% (n = 37)为有利风险,36% (n = 67)为中等风险,40% (n = 74)为不良风险,另有4%的患者因数据缺失而无法完成风险分层。72% (n = 134)为新发AML。70% (n = 130)在第1 - 5天开始化疗诱导,16% (n = 30)在第6 - 10天开始,14% (n = 27)在第11天或之后开始。与诊断后1 - 5天诱导相比,在诊断后11天以上诱导的患者实现CR的概率降低。这种关系具有统计学意义(优势比= 0.32,95%可信区间(CI): 0.125 ~ 0.796;P = 0.003)。然而,当进行多变量分析时,TDT组之间的OS和CR没有差异。结论:我们的回顾性研究显示,基于TDT组的OS没有差异,这支持临床医生在诊断时等待综合AML分析以获得最佳风险分层和实施最佳行动方案的方法。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Does Time Matter From Diagnosis to Induction in Acute Myeloid Leukemia?

Does Time Matter From Diagnosis to Induction in Acute Myeloid Leukemia?

Does Time Matter From Diagnosis to Induction in Acute Myeloid Leukemia?

Background: While molecular and cytogenetic testing may change prognosis and guide treatment intensity for patients with acute myeloid leukemia (AML), timing from diagnosis to treatment (TDT) on the other hand may impact treatment outcomes and survival. These considerations are sometimes at odds with each other given that molecular studies can take up to 2 weeks to result.

Methods: A retrospective cohort analysis was conducted at SUNY Upstate University Hospital to examine the effect of TDT on complete remission (CR) and overall survival (OS). The subjects were at least 18 years old and diagnosed with AML and treated between January 2010 and June 2024. TDT was divided into three categories: chemotherapy induction within 1 - 5, 6 - 10, and 11+ days. Univariate Kaplan-Myer survival analysis and multivariate Cox regression model were performed.

Results: A total of 187 patients were included, and 34% (n = 64) were younger than age 60. Patients were classified as 20% (n = 37) favorable, 36% (n = 67) intermediate, and 40% (n = 74) adverse risk, , while 4% risk stratification could not be completed due to missing data. Seventy-two percent (n = 134) had de novo AML. Chemotherapy induction began for 70% (n = 130) on days 1 - 5, 16% (n = 30) between days 6 - 10, and 14% (n = 27) on day 11 or after. The probability of achieving CR decreases for those who had induction 11+ days from diagnosis compared to those who had induction 1 to 5 days from diagnosis. This relationship was statistically significant (odds ratio = 0.32, 95% confidence interval (CI): 0.125 - 0.796; P = 0.003). However, no differences in OS and CR between TDT groups were seen when multivariate analysis was performed.

Conclusion: Our retrospective study showed no difference in OS based on TDT groups, which supports clinicians' approach to await on comprehensive AML profiling for an optimal risk stratification at diagnosis and implementing best course of action.

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Journal of hematology
Journal of hematology HEMATOLOGY-
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