| OBJECTIVE:Acute leukemia(AL)is a malignant tumor of the blood system,with a high incidence and increasing year by year in China.It has acute onset,rapid progression and high mortality.With the advent of new chemotherapy drugs,biological immune agents,and the maturity of transplantation technology,the clinical prognosis of patients has been continuously improved,but the basic treatment for acute leukemia is still chemotherapy.However,chemotherapy drugs not only kill malignant tumor cells,but also cause damage to normal cells in the human body,which often leads to a variety of adverse reactions.Serious adverse reactions not only reduce the quality of life of patients,but also significantly reduce the therapeutic effect and survival rate of patients.In serious cases,patients will lose confidence in treatment and give up treatment.Even death.It is well known that the occurrence and development of malignant tumors are closely related to inflammation and nutrition.In the field of oncology,many studies have shown that some inflammatory score is closely related to the prognosis of patients,and C-reactive protein to albumin ratio(CAR)has also been shown to be related to the prognosis of a variety of tumors,but its research in hematologic tumors is less and controversial.At present,the prognostic effect of CAR on patients with acute leukemia is unclear.Risk factors for serious adverse effects following chemotherapy are also unclear.In this article,the effect of CAR before chemotherapy on the prognosis of patients with newly diagnosed acute leukemia after the first induction chemotherapy was explored,and the risk factors for serious adverse reactions after chemotherapy were explored.METHODS:To retrospectively analyzed the clinical data,which newly diagnosed patients with acute leukemia confirmed by FAB in the Second Affiliated Hospital of Hainan Medical University from January 2017 to December 2021.All patients were followed up for 1 year or until death.Participants included 71 patients,according to the receiver-operating characteristic(ROC)curve,determine the optimal threshold is1.075,divided the patients into high CAR(1.075 or higher)and low CAR group(<1.075)in two groups.The relevant laboratory indicators before and after chemotherapy were collected,and the adverse reactions within 30 days of chemotherapy were observed.The evaluation was performed according to the common Adverse drug Events Evaluation criteria(CTCAE 5.0).SPSS 27.0 was used for statistical analysis.The measurement data were represented by mean ± standard deviation,the test methods were used t test and non-parametric test,and the count data were tested by Chi-square test,Fisher’s exact test and rank sum test.The survival curve was plotted using Kaplan-Meier method.The predictive variables were selected by backward elimination method,and then included into the Logistic regression model for multivariate analysis.P < 0.05 was statistically significant.RESULTS:There was no statistically significant difference in baseline characteristics between high and low CAR groups.After one cycle of induction chemotherapy,25 patients in the low-CAR group achieved complete response(CR),with a response rate of 50%;3 patients in the high-CAR group achieved CR,with a response rate of14.3%;the CR rate in the low-CAR group was significantly higher than that in the high-CAR group(p=0.007).In the low CAR group,the median 1-year overall survival time was 11 months,1-year overall survival rate was 50%,and 1-year disease-free survival rate was 34%.In the high CAR group,the median 1-year overall survival was3 months,the 1-year overall survival rate was 14.3%,and the 1-year disease-free survival rate was 4.8%.The 1-year overall survival(OS)and disease-free survival(DFS)of the low CAR group were better than those of the high CAR group,and the differences between the two groups were statistically significant(OS p < 0.01,DFS p< 0.01).Among the 71 patients,47.9%(34 patients)had severe adverse reactions to chemotherapy(CTCAE≥ grade 3),and 52.1%(37 patients)had mild adverse reactions.The incidence of serious adverse reactions in the low CAR group was significantly higher than that in the high CAR group(17 cases,34% vs17 cases,80.9%,p < 0.01).logistic regression analysis showed that patients in the high-CAR group had an increased risk of severe adverse reactions after chemotherapy compared with those in the low-CAR group(OR 7.730,95%CI 2.050-29.153,p=0.003).CONCLUSIONS:CAR is a simple,accessible,and effective inflammatory score.The value of CAR before chemotherapy is an independent risk factor for serious adverse effects of chemotherapy.The value of CAR before chemotherapy has prognostic value in patients with acute leukemia undergoing induction therapy. |
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