评估巴西成人ALL早期死亡的危险因素
Lucca Marcon Losso1, Pablo Dossi Nascimento de Azevedo1, Ana Paula Alencar de Lima Lange1
1Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
JCO global oncology
|February 4, 2026
概括
成年急性淋巴细胞白血病 (ALL) 的早期死亡率在低收入国家很高. 低白蛋白和前期循环胺的使用是这些患者早期死亡的关键风险因素.
科学领域:
- 血液学 血液学 血液学
- 在瘤学瘤学.
- 全球健康 全球健康
背景情况:
- 成年急性淋巴细胞白血病 (ALL) 治疗依赖于密集化疗.
- 在低收入和中等收入国家 (LMICs) 中,新型代理商往往无法获得.
- 在LMICs中,早期死亡率明显高 (10-25%) 与高收入国家相比 (<5%).
研究的目的:
- 为了确定LMIC中成年ALL患者早期死亡 (EM) 的风险因素.
- 为制定具体的干预措施提供信息,以减少EM.
- 在资源有限的环境中应对ALL管理的挑战.
主要方法:
- 在2009年至2023年期间诊断的成人ALL患者 (≥15岁) 的回顾性队列研究.
- 早期死亡率定义为诊断后30天内死亡.
- 分析包括患者,无论表型或费城染色体状况如何.
主要成果:
- 在203名患者 (平均年龄36岁) 中,整体EM为9.8%.
- 显著的EM预测因素包括年龄,低白蛋白,环胺使用和肥胖.
- 低白蛋白和预相环胺的使用与感染风险增加和EM有很强的关联.
结论:
- 在LMICs中EM升高反映了晚诊断和有限的支持性护理等挑战.
- 低白蛋白和预相环胺是成人ALL中EM的关键风险标志物.
- 需要适应当地方案和简单的风险分层来降低LMICs中的EM.
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