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Real-World Presentation and Prognostic Effect of Allogeneic Blood Transfusion during the Intensive Induction Phase in Pediatric Acute Lymphoblastic Leukemia

SIMPLE SUMMARY: In China, approximately 15,000 cases of childhood acute lymphoblastic leukemia (ALL) are diagnosed each year, and it is also the most common hematological cancer and the leading cause of tumor death under the age of 18. At present, ALL remains one of the major indications for allogen...

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Autores principales: Qiu, Kunyin, Liao, Xiongyu, Li, Yang, Huang, Ke, Xu, Honggui, Fang, Jianpei, Zhou, Dunhua
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10526786/
https://www.ncbi.nlm.nih.gov/pubmed/37760431
http://dx.doi.org/10.3390/cancers15184462
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author Qiu, Kunyin
Liao, Xiongyu
Li, Yang
Huang, Ke
Xu, Honggui
Fang, Jianpei
Zhou, Dunhua
author_facet Qiu, Kunyin
Liao, Xiongyu
Li, Yang
Huang, Ke
Xu, Honggui
Fang, Jianpei
Zhou, Dunhua
author_sort Qiu, Kunyin
collection PubMed
description SIMPLE SUMMARY: In China, approximately 15,000 cases of childhood acute lymphoblastic leukemia (ALL) are diagnosed each year, and it is also the most common hematological cancer and the leading cause of tumor death under the age of 18. At present, ALL remains one of the major indications for allogeneic blood (ABT). This study aims to determine associations between ABT during the intensive induction phase of therapy and prognostic effect in a real-world cohort of pediatric patients with ALL. We found that among the blood products, only fresh frozen plasma (FFP) infusion is closely related to the prognosis of childhood ALL. During the intensive induction phase, the indications of FFP transfusion should be strictly grasped, and the total amount of FFP should be controlled and kept below 25 mL/kg. ABSTRACT: Purpose: To determine associations between allogeneic blood transfusion (ABT) during the intensive induction phase of therapy and prognostic effect in a real-world cohort of pediatric patients with acute lymphoblastic leukemia (ALL). Methods: A total of 749 pediatric patients who were diagnosed with ALL were enrolled in this study by using a single-center retrospective cohort study method from February 2008 to May 2022. Results: Among the ABT patients, 711 (94.9%) children were transfused with packed red blood cells (PRBCs), 434 (57.9%) with single-donor platelets (SDPs), and 196 (26.2%) with fresh frozen plasma (FFP). Our multivariate analysis demonstrated that FFP transfusion was the unique independent factor that affected both relapse-free survival (RFS) and overall survival (OS). The transfusion of FFP was significantly associated with higher age (p < 0.001), being more likely to receive SCCLG-ALL-2016 protocol (p < 0.001), higher proportion of more than 25 blood product transfusions, more PRBC transfusion (p < 0.001), and higher D33-MRD-positive rates (p = 0.013). Generalized additive models and threshold effect analysis using piece-wise linear regression were applied to identify the cut-off value of 25 mL/kg for average FFP transfusion. K-M survival analysis further confirmed that average FFP transfusion > 25 mL/kg was an independent adverse indicator of inferior outcome in terms of RFS (p = 0.027) and OS (p = 0.033). Conclusions: In blood products, only FFP supplement is closely related to the prognosis of childhood ALL. During the intensive induction phase, the indications of FFP transfusion should be strictly grasped, and the total amount of FFP should be controlled and kept below 25 mL/kg.
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spelling pubmed-105267862023-09-28 Real-World Presentation and Prognostic Effect of Allogeneic Blood Transfusion during the Intensive Induction Phase in Pediatric Acute Lymphoblastic Leukemia Qiu, Kunyin Liao, Xiongyu Li, Yang Huang, Ke Xu, Honggui Fang, Jianpei Zhou, Dunhua Cancers (Basel) Article SIMPLE SUMMARY: In China, approximately 15,000 cases of childhood acute lymphoblastic leukemia (ALL) are diagnosed each year, and it is also the most common hematological cancer and the leading cause of tumor death under the age of 18. At present, ALL remains one of the major indications for allogeneic blood (ABT). This study aims to determine associations between ABT during the intensive induction phase of therapy and prognostic effect in a real-world cohort of pediatric patients with ALL. We found that among the blood products, only fresh frozen plasma (FFP) infusion is closely related to the prognosis of childhood ALL. During the intensive induction phase, the indications of FFP transfusion should be strictly grasped, and the total amount of FFP should be controlled and kept below 25 mL/kg. ABSTRACT: Purpose: To determine associations between allogeneic blood transfusion (ABT) during the intensive induction phase of therapy and prognostic effect in a real-world cohort of pediatric patients with acute lymphoblastic leukemia (ALL). Methods: A total of 749 pediatric patients who were diagnosed with ALL were enrolled in this study by using a single-center retrospective cohort study method from February 2008 to May 2022. Results: Among the ABT patients, 711 (94.9%) children were transfused with packed red blood cells (PRBCs), 434 (57.9%) with single-donor platelets (SDPs), and 196 (26.2%) with fresh frozen plasma (FFP). Our multivariate analysis demonstrated that FFP transfusion was the unique independent factor that affected both relapse-free survival (RFS) and overall survival (OS). The transfusion of FFP was significantly associated with higher age (p < 0.001), being more likely to receive SCCLG-ALL-2016 protocol (p < 0.001), higher proportion of more than 25 blood product transfusions, more PRBC transfusion (p < 0.001), and higher D33-MRD-positive rates (p = 0.013). Generalized additive models and threshold effect analysis using piece-wise linear regression were applied to identify the cut-off value of 25 mL/kg for average FFP transfusion. K-M survival analysis further confirmed that average FFP transfusion > 25 mL/kg was an independent adverse indicator of inferior outcome in terms of RFS (p = 0.027) and OS (p = 0.033). Conclusions: In blood products, only FFP supplement is closely related to the prognosis of childhood ALL. During the intensive induction phase, the indications of FFP transfusion should be strictly grasped, and the total amount of FFP should be controlled and kept below 25 mL/kg. MDPI 2023-09-07 /pmc/articles/PMC10526786/ /pubmed/37760431 http://dx.doi.org/10.3390/cancers15184462 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Qiu, Kunyin
Liao, Xiongyu
Li, Yang
Huang, Ke
Xu, Honggui
Fang, Jianpei
Zhou, Dunhua
Real-World Presentation and Prognostic Effect of Allogeneic Blood Transfusion during the Intensive Induction Phase in Pediatric Acute Lymphoblastic Leukemia
title Real-World Presentation and Prognostic Effect of Allogeneic Blood Transfusion during the Intensive Induction Phase in Pediatric Acute Lymphoblastic Leukemia
title_full Real-World Presentation and Prognostic Effect of Allogeneic Blood Transfusion during the Intensive Induction Phase in Pediatric Acute Lymphoblastic Leukemia
title_fullStr Real-World Presentation and Prognostic Effect of Allogeneic Blood Transfusion during the Intensive Induction Phase in Pediatric Acute Lymphoblastic Leukemia
title_full_unstemmed Real-World Presentation and Prognostic Effect of Allogeneic Blood Transfusion during the Intensive Induction Phase in Pediatric Acute Lymphoblastic Leukemia
title_short Real-World Presentation and Prognostic Effect of Allogeneic Blood Transfusion during the Intensive Induction Phase in Pediatric Acute Lymphoblastic Leukemia
title_sort real-world presentation and prognostic effect of allogeneic blood transfusion during the intensive induction phase in pediatric acute lymphoblastic leukemia
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10526786/
https://www.ncbi.nlm.nih.gov/pubmed/37760431
http://dx.doi.org/10.3390/cancers15184462
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