Early Mortality In Hyperleukocytosis In Patients With Acute Myeloid Leukemia: A Systematic Review and Meta-Analysis
Notice bibliographique
Résumé
Abstract Background Hyperleukocytosis in acute myeloid leukemia (AML) is associated with early deaths, typically related to respiratory failure and intracranial ischemia/hemorrhage. Various interventions for leukoreduction including leukapheresis, low-dose chemotherapy and hydroxyurea have been used in an attempt to decrease mortality. However, there are no randomized trials and observational trials are biased. We undertook a systematic review and meta-analysis to evaluate the effect of these interventions using an “intent-to-treat” approach and classifying studies as always, sometimes and never using these interventions. Objectives The primary objective was to describe the proportion of early deaths in patients with AML with an initial WBC ≥ 100,000x109/L stratified by the approach to leukapheresis and hydroxyurea/low dose chemotherapy (universal, sometimes or never). The secondary objective was to compare the proportion of early deaths in patients who did and did not receive leukapheresis. Methods Electronic searches of Ovid Medline from 1980 to July 12, 2013, EMBASE from 1980 to July 12, 2013 and Cochrane Central Register of Controlled Trials until June 2013 were conducted. Studies were included if: (1) Population included patients with AML; and (2) Either described the proportion of patients with early deaths in patients with an initial WBC ≥ 100,000x109/L or compared the proportion of early deaths by receipt of leukapheresis in patients using the same initial WBC threshold. Studies including solely acute promyelocytic leukemia (APML) patients were excluded. The pre-specified subgroups in the evaluation of early death proportions were whether leukapheresis and low-dose chemotherapy/hydroxyurea were intended to be applied universally, sometimes or never in hyperleukocytosis. These subgroups were defined based on the study’s stated policy independent of the number of patients actually receiving the intervention. Two investigators assessed the quality of the included studies for selection and confounding bias using the Hayden framework. Synthesis of proportions was conducted using RevMan. Meta-regression was conducted in which the natural log of the proportion of early deaths was modelled. Heterogeneity was assessed by visual inspection and I2. Results Twenty studies representing 1427 patients were included in the final meta-analysis. Overall, the proportion of early deaths (19 studies, 1281 patients) was 19.9% (95% CI: 14.7-25.1). Table 1 illustrates that neither leukapheresis strategy nor hydroxyurea/low dose chemotherapy influenced the early death rate. Meta-regression evaluating the percent of patients receiving leukapheresis showed no relationship with early death rate (odds ratio 1.01, 95% CI: 0.99-1.02; P=0.249). Evaluation of leukapheresis within studies included 7 studies of which 6 were at high risk of confounding bias and sufficiently heterogeneous to not permit synthesis. Conclusion Early mortality related to hyperleukocytosis is high and is not influenced by universal or selected use of leukapheresis or low-dose chemotherapy/hydroxyurea. This meta-analysis does not support these interventions for patients with AML and hyperleukocytosis. Novel approaches are required to decrease mortality. Disclosures: Lehrnbecher: Gilead: Honoraria; MSD: Honoraria; Pfizer: Honoraria; Astellas: Honoraria.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,011 | 0,027 |
| Méta-épidémiologie (sens strict) | 0,002 | 0,001 |
| Méta-épidémiologie (sens large) | 0,016 | 0,035 |
| Bibliométrie | 0,007 | 0,008 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,003 | 0,002 |
| Science ouverte | 0,002 | 0,001 |
| Intégrité de la recherche | 0,002 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».