Study On Incidence And Risk Factors Of Hepatic Injury During Induction Therapy For Acute Promyelocytic Leukemia

Acute myeloid leukemia is a clonal malignant disease of bone marrow stem cells.Approximately 12330 people will be diagnosed with AML in 2010, and 8950 patients will die from the disease. Acute promyelocytic leukemia is a special subgroup of AML, accounting for about 6.2%-40.2%of acute myeloid leukemia. More than 90% patients get complete remission and about 70% patients are survival in 5 years after they use advanced chemotherapy. But both all-trans retinoic acid and arsenic trioxide can induce hepatic injury, that influence the therapeutic effects and quality of life of patients. There is no study on risk factors of liver injury during induction therapy of APL.Objective:To investigate the incidence and risk factors of induction chemotherapy-induced liver disease of APL patients.Methods:Liver disease was classified into three grades asmild, moderate and severe according to the criteria established on European Drug Conference in 1990 Seventy cases of AML patients were studied who received treatment in the hematological department of First Hospital of Jilin University from 2008 to 2011 Statistics methods such as Chi2square test and wilcoxon were used to investigate the correlation between the incidence and the risk factors of liver disease(P>0.05).Results:The incidence of liver disease of sixty five APL patients was 73.85%, including 33.33%mild, 50% moderate and 16.67% severe liver disease. Single factor analysis showed that male could increase the incidence of liver disease(P<0.05). Increasing WBC during induction therapy and liver injury are raleted(P<0.05). We make ROC curve based on Leukocytosis times and liver injury, that indicates it is significant that use Leukocytosis times to diagnose liver damage during induction therapy of APL. From that, we get the cutoff value is 4.78, when the sensitivity is 68.8%, specificity is 70.6%. It is higher that the rate of liver injury in moderate risk group than it in high risk group(P<0.05). The incidence of liver disease was not significantly correlated with age, type of APL fusion gene, HBV, renal function and albumin before therapy, prophylactic use of glutathione.Conclusion: The rate of liver disease during induction therapy of APL was 73.85%, dominated by mild to moderate. The risk factors of induced liver disease include raising number of white blood cells. The rate of liver disease of male APL is higher than that of female APL during induction therapy.