Роль интенсивной терапии в лечении больных острыми миелоидными лейкозами
Роль интенсивной терапии в лечении больных острыми миелоидными лейкозами
Баженов А.В., Галстян Г.М., Паровичникова Е.Н. и др. Роль интенсивной терапии в лечении больных острыми миелоидными лейкозами. Терапевтический архив. 2019; 91 (7): 14–24. DOI: 10.26442/00403660.2019.07.000321
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Bazhenov A.V., Galstyan G.M., Parovichnikova E.N., et al. Role of the intensive care in treatment of patients with acute myeloid leukemia Therapeutic Archive. 2019; 91 (7): 14–24. DOI: 10.26442/00403660.2019.07.000321
Роль интенсивной терапии в лечении больных острыми миелоидными лейкозами
Баженов А.В., Галстян Г.М., Паровичникова Е.Н. и др. Роль интенсивной терапии в лечении больных острыми миелоидными лейкозами. Терапевтический архив. 2019; 91 (7): 14–24. DOI: 10.26442/00403660.2019.07.000321
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Bazhenov A.V., Galstyan G.M., Parovichnikova E.N., et al. Role of the intensive care in treatment of patients with acute myeloid leukemia Therapeutic Archive. 2019; 91 (7): 14–24. DOI: 10.26442/00403660.2019.07.000321
Цель. Индукция ремиссии у больных острыми миелоидными лейкозами (ОМЛ) может привести к угрожающим жизни осложнениям, требующим перевода в отделение реанимации и интенсивной терапии (ОРИТ). Цель работы – оценить влияние интенсивной терапии угрожающих жизни осложнений на краткосрочные и отдаленные результаты лечения больных ОМЛ. Материалы и методы. В ретроспективное исследование включены больные с de novo ОМЛ старше 18 лет, которые были разделены на группы, кому потребовался перевод в ОРИТ (группа с ОРИТ) и не нуждавшихся в переводе в ОРИТ (группа без ОРИТ). Регистрировали структуру и результаты лечения критических синдромов, сравнивали между группами демографические показатели, молекулярно-цитогенетический риск, проводившуюся химиотерапию, краткосрочные и отдаленные результаты лечения ОМЛ. Использовали методы описательной статистики, вероятность дожития по методу Каплана–Майера. Результаты. В исследование включено 76 больных ОМЛ. Перевод в ОРИТ потребовался 37% больных. Причины перевода: острая дыхательная недостаточность (50%), септический шок (14,3%), нарушение мозгового кровообращения (17,9%), экстренное родоразрешение (10,7%), острая аритмия (7,1%). Пациенты группы с ОРИТ не отличались от пациентов группы без ОРИТ по возрасту, частоте цитогенетически неблагоприятных форм ОМЛ, но в группе с ОРИТ были более выраженные анемия, лейкоцитоз, большее количество бластных клеток в крови и костном мозге. Факторами неблагоприятного исхода в ОРИТ были септический шок и искусственная вентиляция легких. В группе ОРИТ 28-дневная общая выживаемость (ОВ) составила 64,3%, 5-летняя ОВ – 43,2%, 5-летняя безрецидивная выживаемость (БРВ) – 34%, медиана БРВ – 16,4 мес; в группе без ОРИТ – соответственно 100, 53, 44% и 23,5 мес (p=0,504). Заключение. Отдаленные результаты лечения больных ОМЛ, которым понадобилась интенсивная терапия, значимо не отличаются от результатов лечения больных без этих осложнений.
Aim. Remission induction can be associate, with the life threatening complications and transfer to ICU of de novo acute myeloid leukemia (AML) patients (pts). We evaluate influence of transfer to ICU and life threatening complication on early mortality and long-tram survival of de novo AML pts. Materials and methods. Retrospective study. All de novo AML pts younger than 60 years old admitted in the National Research Center for Hematology from 2013 to 2016 years were enrolled in the study. Patients were divided into 2 groups: pts who were required ICU admission during remission induction (ICU-pts) and pts who did not require ICU admission and received chemotherapy only in hematology ward (non-ICU pts). The reasons for ICU admissions and results of life support were analyzed. Overall survival (OS) were assessed by the Kaplan–Meier method, long rank value p<0.05 consider as significant. Univariate analysis was performed with χ2 tests or Fisher's exact tests for categorical variables to find an independent ICU mortality predictor. Results. In total 76 pts were included. 37% of pts required admission to ICU. Reasons for the ICU admissions were: acute respiratory failure (50%), septic shock (14.3%), cerebrovascular accident (17.9%), emergency caesarian section (10.7%), cardiac arrhythmia (7.1%). There were no difference in demography, group of risk (ELN) in ICU and non-ICU pts, but in ICU pts anemia, leukocytosis were more severe. Need for vasopressors and mechanical ventilations were mortality predictors. ICU survival rate was 63.4%. A landmark analysis for overall survival (OS) was performed for patients who survived after life threatening complication in ICU group: 5-year OS – 43.2%, 5-year disease free survival (DFS) – 34%. In non-ICU group 5-yeas OS – 53%, 5-year DSF – 44% (p=0.504). Conclusion. After discharging from ICU the long-term prognosis of ICU-pts is not worse, than non-ICU pts.
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1. McGuire S. World Cancer Report 2014. Geneva, Switzerland: World Health Organization, International Agency for Research on Cancer, WHO Press, 2015. Adv Nutr An Int Rev J. 2016;7(2):418-9. doi: 10.3945/an.116.012211
2. Dizon D, Krilov L, Cohen E. Clinical Cancer Advances 2016: Annual Report on Progress Against Cancer From the American Society of Clinical Oncology. J Clin Oncol. 2016;34(9):987-1011. doi: 10.1200/JCO.2015.65.8427
3. Garcia-Manero G, Othus M, Pagel J. SWOG S1203: A Randomized Phase III Study of Standard Cytarabine Plus Daunorubicin (7+3) Therapy Versus Idarubicin with High Dose Cytarabine (IA) with or without Vorinostat (IA+V) in Younger Patients with Previously Untreated Acute Myeloid Leukemia (AML). Blood. 2016;128(22). http://www.bloodjournal.org/content/128/22/901?sso-checked=true. Accessed March 6, 2018.
4. Burnett A, Russell N, Hills R. A randomized comparison of daunorubicin 90 mg/m 2 vs 60 mg/m 2 in AML induction: results from the UK NCRI AML17 trial in 1206 patients. Blood. 2015;125(25):3878-85. doi: 10.1182/blood-2015-01-623447
5. Döhner H, Estey E, Grimwade D. Diagnosis and management of AML in adults: 2017 ELN recommendations from an international expert panel. Blood. 2017;129(4):424-47. doi: 10.1182/blood-2016-08-733196
6. Denardo S, Oye R, Bellamy P. Efficacy of intensive care for bone marrow transplant patients with respiratory failure. Crit Care Med. 1989;17(1):4-6. http://www.ncbi.nlm.nih. gov/pubmed/2642401. Accessed July 13, 2017.
7. Schuster D. Everything that Should Be Done—Not Everything that Can Be Done. Am Rev Respir Dis. 1992;145(3):508-9. doi: 10.1164/ajrccm/145.3.508
8. Turnbull A, Carlon G, Baron R, Sichel W, Young C, Howland W. The inverse relationship between cost and survival in the critically ill cancer patient. Crit Care Med. 1979;7(1):20-3. http://www.ncbi.nlm.nih.gov/pubmed/104824. Accessed July 11, 2017.
9. Crawford S, Petersen F. Long-term Survival from Respiratory Failure after Marrow Transplantation for Malignancy. Am Rev Respir Dis. 1992;145(3):510-4. doi: 10.1164/ajrccm/ 145.3.510
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1 ФГБУ «Национальный медицинский исследовательский центр гематологии» Минздрава России, Москва, Россия;
2 ГБУЗ «Центр планирования семьи и репродукции» Департамента здравоохранения города Москвы, Москва, Россия