Analysis Of Clinical Characteristics And Related Factors Of Differentiation Syndrome In Acute Promyelocytic Leukemia

Objective:Acute promyelocytic leukemia(APL)is a unique subtype of acute myeloid leukemia(AML),accounting for 10%to 15%of the incidence rate of acute myeloid leukemia.Newly diagnosed APL patients can achieve a complete response rate of 90%to 95%after receiving all-trans retinoic acid(ATRA)and(or)arsenite trioxide(ATO)induction therapy.During induction therapy,because DS has an acute onset and a dangerous condition,which causes APL patients to die early in the disease,it is clinically necessary to be vigilant against the appearance of Differentiation Syndrome(DS).The purpose of this study was to find the relevant risk factors for the occurrence of DS by analyzing the clinical characteristics and related factors of DS in newly diagnosed APL patients.This is to guide the clinical diagnosis of the disease accurately and timely treatment of the disease.This has important implications for reducing early mortality in patients with APL.Methods:A total of 65 newly diagnosed APL patients who were treated in the Hematology Department of Northern Jianfsu People's Hospital from January 1,2014 to December 31,2019 were selected.All patients were tested for blood routine,biochemical tests,blood coagulation routine,bone marrow cell morphology,immunotyping,chromosomes and fusion genes.The diagnosis of all patients met the diagnostic criteria in the Chinese Guidelines for the Diagnosis and Treatment of Acute Promyelocytic Leukemia(2018 Edition).Analysis was performed using SPSS 24.0software.By drawing the ROC curve,the cut-off value of the white blood cell maximum after chemotherapy was determined,and its sensitivity and specificity were analyzed.The number of cases(%)is used to represent the count data,and the independent sample chi-square test and Fisher exact probability method are used to compare the differences between the count data.Multivariate comparison was performed using logistic regression analysis.The relationship between DS and prognosis was analyzed by Kaplan-Meier survival analysis.P<0.05 was defined as a statistically significant difference.Results:1.Of the 65 newly diagnosed APL patients,there were 40 males and 25 females,with a male to female ratio of 1.6:1;the median age was 48(15-78)years;61 patients achieved complete remission,The median time was 30(21 to 45)days,and the CR rate reached 93.8%(61/65).Four patients died of different diseases and did not obtain CR,so the early mortality rate was 6.2%(4/65).2.There were 29 patients in the DS group and 36 patients in the non-DS group,so the incidence of DS was 44.6%(29/65).The median time for DS to occur was 6(2 to 20)days.There were 14 patients in the severe DS group and 15 patients in the mild DS group.The most common clinical symptom of DS is fever(82.8%),followed by dyspnea(79.3%).Among them,the incidence of pulmonary infiltration(P=0.025),renal failure(P=0.042),pericardial effusion(P=0.017),and edema(P=0.002)was significantly higher in the severe DS group than in the mild DS group.3.By drawing the ROC curve,the cut-off value of the maximum white blood cell after chemotherapy was defined as 20×10~9/L.The univariate analysis showed that the maximum value of white blood cells after chemotherapy was greater than 20×10~9/L(P=0.005),and the body mass index(BMI)?24kg/m~2(P=0.025)was statistically significant in the DS group and the non-DS group.Differences;multivariate analysis showed that peak white blood cells after chemotherapy>20×10~9/L(P=0.029,OR=1.023)and BMI?24kg/m~2(P=0.015,OR=3.888)were independent predictors of DS.4.Patients'gender,age,prognostic stratification,weight gain,peripheral blood leukocyte count at first diagnosis,abnormal promyelocyte ratio in peripheral blood,abnormal promyelocyte ratio in bone marrow,additional gene mutation(FLT3-ITD,WT-1).There was no statistical difference between LDH in DS group and non-DS group(P>0.05).5.To the end of the follow-up,the median follow-up time was 35(1.7 to 72.3)months.Of the 61 patients with CR,3 patients died due to recurrence of the disease during maintenance treatment.The 5-year overall survival rate for this study case was89.2%(58/65).The 5-year overall survival rate of patients in the DS group was significantly lower than that in the non-DS group(P=0.024),which was statistically different.The 5-year overall survival rate of patients in the severe DS group was lower than that in the mild DS group(P=0.336),but there was no statistical difference.Conclusion:1.This study analyzed a total of 65 newly diagnosed APL patients,and 29 patients were in the DS group.Fever was the most common clinical symptom in the DS group,followed by dyspnea.Among them,the incidence of pulmonary infiltration,renal failure,pericardial effusion,and edema in the severe DS group was higher than that in the mild DS group.2.The 5-year overall survival rate of patients with DS was significantly lower than that without DS,indicating that DS shortened the survival of patients with APL.3.The maximum leukocytes after chemotherapy>20×10~9/L and BMI?24kg/m~2are independent predictors of DS.