Retrospektive Untersuchung von Risikofaktoren eines Frühtodes bei 10 Patienten mit akuter Promyelozytenleukämie am UKGM Marburg
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Abstract
Acute promyelocytic leukemia (APL) is a rare subtype of acute myeloid leukemia (AML).
It is considered a disease with a high cure rate. APL is diagnosed based on detection of
the PML::RARA fusion gene. Despite ongoing therapy, early mortality among patients
remains a significant challenge, frequently attributed to hemorrhagic events or infections.
In this study, the question was addressed as to whether statistically significant risk factors
for early death (ED for short) of patients can be shown based on the available laboratory
parameters on admission and during the subsequent days of specific therapy up to day 3
(referred to as D0 and day 1 to day 3). The term early death typically refers to death within
30 days of diagnosis or during treatment. Retrospectively, all available clinical and labor-
atory findings of 4 patients at the UKGM Marburg with ED-APL and 6 APL control
patients were evaluated. Mean age of patients with early death was found to be signifi-
cantly higher than in the control group (65.51 years versus 48.57 years), while gender
was of no no statistical significance (p = 1).
All ED-APL patients included had the BCR3 variant of the PML::RARα fusion protein
(p = 0,035). On average, there was a marginally higher likelihood of CD34 positivity. On
admission (D0, calculated as the mean of all laboratory values on day 1 and day 2 during
the course), the parameters magnesium (mmol/l) (p = 0.010), protein (g/l) ((p = 0.005),
GFR (ml/min) ( p < 0.001), urea (mg/dl) ((p = 0.022), MCHC (g/l erythrocytes) (p =
0.001), Quick TPZ (%) (p = 0.0), International Normalized Ratio (INR) (p = 0.007) and
D-dimers (μg/l) (p = 0.007) were significant risk factors. On day 3 after admission, under
treatment, the parameters calcium (mmol/l) (p = 0.042), total bilirubin (mg/dl) (p = 0.001);
GFR (ml/min) (p = 0.041), erythrocyte count (T/l) (p = 0.004), hemoglobin (g/l)
( p < 0.001), hematocrit (L/L) (p = 0.002), Quick value TPZ (%) (p = 0.007), INR
( p < 0.001) and also antithrombin (%) (p = 0.006) were associated with early death. In a
subsequent detailed statistical analysis, levels of sodium, creatinine, and Quick value TPZ
were observed to have significantly changed from day 1 to day 2 in both groups. Sodium,
magnesium, calcium, urea, protein and bilirubin have not yet been described as potential
risk factors in this specific context in literature. Low fibrinogen, high white blood cell
count and low platelets were factors influencing the risk of early death in previous studies
but not in the cohort at the UKGM. The study's findings may assist in identifying APL
patients who are at a higher risk of early mortality at an early stage and ensure they receive
suitable treatment promptly.
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This item has been published with the following license: In Copyright