ABSTRACT
Objective To explore the clinical features, curative effects and prognosis of patients with psoriasis related acute leukemia. Methods The clinical data of 39 cases in the Second Hospital Shanxi Medical University from January 2011 to June 2016 were collected, and their clinical features and prognosis were analyzed retrospectively. Results Of 39 patients, 28 were males and 11 were females, with the median age of 42 years (13-76 years), the median time that suffering from psoriasis were 10 years (1-30 years); There were 23 (59.0 ％) patients with acute promyelocytic leukemia (APL), 13 (33.3 ％) patients with acute myeloid leukemia (AML) and 3 (7.7 ％) patients with B-cell acute lymphocytic leukemia (B-ALL). In patients with recurrence, there were 4 patients with APL, 4 patients with AML, and 1 patient with B-ALL. Single factor analysis showed that the type of PML-RARαfusion gene isoform and the time of suffering from psoriasis were the influencing factors of patients with APL recurrence (both P<0.05), but they were not the independent risk factors (both P>0.05) based on multivariate analysis. The complete remission (CR) rates of patients with psoriasis related APL and AML were 96％(22/23) and 46％(6/13), the 3-year overall survival (OS) rates were 96％and 44％, 3-year relapse free survival (RFS) rates were 77％and 38％, respectively. Conclusions In patients with psoriasis related acute leukemia, the largest population is APL patients, and they have a better prognosis. However, patients with psoriasis related AML and ALL have low CR rate and OS rate, and the allogeneic hematopoietic stem cell transplantation should be considered after remission.
ABSTRACT
Objective To analyze the clinical features and risk factors for an emerging infection during the first induction chemotherapy in elderly patients with acute leukemia.Methods A retrospective analysis of clinical data of 79 elderly patients with newly diagnosed acute leukemia was performed in Second Hospital of Shanxi Medical University from January 2014 to May 2016.Results The 70 cases among 79 elderly patients with acute leukemia were suffered from infection with infection incidence rate of 88.6％ (70/79)during first induction chemotherapy.The infection-related fatality rate was 8.6 ％ (6/70).Being clear about sites of infection accounted for 90.0 ％ (63/70),and the top three infection sites were the lungs,gastrointestinal tract and the bloodstream.113 pathogenic strains were detected,including gram-negative bacilli accounting for 42.5 ％ (48/113),Gram-positive cocci for 30.1％ (34/113),fungi for 24.8％ (28/113),the virus for 2.7％ (3/113).Based on clinically and confirmatively diagnosis,the invasive fungal diseases mostly as Candida accounted for 30.4 ％ (24/79),mixed infections accounted for 34.3％ (24/70).Univariate analysis showed agranulocytosis and AML were risk factors for infection.Logistic multivariate regression analysis showed that agranulocytosis was a risk factor for infection (OR=12.010,95％CI:2.346-107.973,P=0.000).The infection does not affect a complete remission rate of acute leukemia (x2 =0.001,P=0.983).Conclusions For newly diagnosed elderly acute leukemia patients,an emerging infection during the first induction chemotherapy is characterized by a high incidence,high fungal infection rate,most common site in lung,Gram-negative bacteria as most common pathogen,and an increased infection rate by agranulocytosis.The infection does not affect the remission rate of acute leukemia.