Analysis of the efficacy and prognosis of radiotherapy in acute leukemia with extramedullary infiltration
10.3969/j.issn.1671-8348.2024.04.014
- VernacularTitle:放疗在急性白血病合并髓外浸润的疗效和预后分析
- Author:
Wenbin LEI
1
,
2
;
Hui LIU
;
Yan ZHANG
;
Yinghao LU
;
Yi HUANG
;
Ying CHEN
;
Rui GAO
;
Xiao CHAI
;
Yun ZHAN
;
Jie XIONG
;
Lingyun WANG
;
Lei LIU
;
Jishi WANG
;
Peng ZHAO
Author Information
1. 贵州医科大学,贵阳 550004
2. 贵州医科大学附属医院血液科,贵阳 550004
- Keywords:
acute leukemia;
extramedullary infiltration;
radiation therapy;
hematological toxicity;
prog-nosis;
survival analysis
- From:
Chongqing Medicine
2024;53(4):547-554
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the clinical characteristics,treatment methods,and prognosis of a-cute leukemia patients with extramedullary infiltration.Methods The clinical characteristics and treatment methods of 47 acute leukemia patients with extramedullary infiltration admitted to the Affiliated Hospital of Guizhou Medical University from April 2014 to April 2023 were retrospectively analyzed.Subgroup analysis was performed according to whether there was extramedullary infiltration before transplantation,and whether there was isolated extramedullary recurrence after transplantation.Based on this analysis,the patients were di-vided into the pre-transplantation radiotherapy group and pre-transplantation non-radiotherapy group,the post-transplantation radiotherapy group and post-transplantation non-radiotherapy group.According to the treatment methods of central nervous system leukemia(CNSL),the patients were divided into the intrathecal injection group(n=12)and combination of intrathecal injection and radiotherapy group(n=13).The local remission situation,survival duration,and toxic and side effects of radiotherapy and chemotherapy were com-pared.Results For acute leukemia patients with extramedullary infiltration,the overall survival time(OS)in the radiotherapy group was better than that in the non-radiotherapy group(median OS:706 d vs.151 d,P=0.015).Subgroup analysis showed that the OS of the pre-transplantation radiotherapy group was better than that of the pre-transplantation non-radiotherapy group(median OS:592 d vs.386 d,P=0.035).For CNSL,the combination of intrathecal injection and radiotherapy group had a better OS than the intrathecal injection group(median OS:547 d vs.388 d,P=0.045).The event-free survival time(EFS)of the radiotherapy group was better than that of the non-radiotherapy group(median EFS:175 d vs.50 d,P=0.005).The COX pro-portional-hazards model showed that treatment with or without radiotherapy had a significant impact on the OS of acute leukemia patients with extramedullary infiltration.The risk of death in the pre-transplantation non-radiotherapy group was 2.231 times higher than that in the pre-transplantation radiotherapy group(HR=3.231,95％CI:1.021-10.227,P=0.046).Compared with the non-radiotherapy group,the radiother-apy group had a higher local remission and a lower risk of haematological toxicity,infection,and haemorrhage.Conclusion Radiotherapy can rapidly alleviate the local symptoms of acute leukemia complicated with extr-amedullary infiltration,prolong the survival time of these patients,and reduce the risk of hematologic toxicity,infection,and haemorrhage.
