Supplementary Material for: Defining current patterns of blood product use during intensive induction chemotherapy in newly diagnosed acute myeloid leukemia patients

Introduction: Blood product transfusion retains a critical role in the supportive care of patients with acute myeloid leukemia (AML). Whereas previous studies have shown increased transfusion dependency to portend inferior outcome, predictive factors of an increased transfusion burden and the prognostic impact of transfusion support have not been assessed recently. Methods/Patients: We performed a retrospective analysis of a recent cohort of patients given intensive induction chemotherapy in 2014-2022. Results: The analysis comprised 180 patients with a median age of 57 years with 80% designated as de novo AML. Fifty-four patients (31%) were FLT3-ITD mutated and 73 patients (42%) harbored NPM1. Favorable risk and intermediate risk ELN 2017 patients accounted for 43% and 34% of patients, respectively. The median number of red blood cell (RBC) and platelet units given during induction were 9 units and 7, respectively. Seventeen patients (9%) received cryoprecipitate and fresh frozen plasma (FFP) was given to 12 patients (7%). Lower initial hemoglobin and platelet levels were predictive of increased use of RBC (p<0.0001) and platelet transfusions (p<0.0001). FFP was significantly associated with induction related mortality (42% versus 5%; p<0.0001) and with FLT3-ITD (72% versus 28%; p=0.004). Blood group AB experienced improved mean overall survival compared to blood group O patients (4.1 years versus 2.8 years; p=0.025). In multivariate analysis, increased number of FFP [hazard ratio (HR), 4.23; 95% confidence interval (CI), 2.1-8.6; p<0.001) and RBC units (HR, 1.8; 95% CI, 1.2-2.8; p=0.008) given was associated with inferior survival. Conclusion: Transfusion needs during induction crucially impact the clinical trajectory of AML patients.

引言：血液制品输注在急性髓系白血病（acute myeloid leukemia, AML）患者的支持治疗中仍发挥着关键作用。既往研究已证实输注依赖程度升高预示不良预后，但近年来尚未有研究对输注负荷增加的预测因素以及输注支持的预后影响进行评估。
方法与研究对象：我们对2014-2022年接受强化诱导化疗的新近患者队列开展了回顾性分析。
结果：本分析共纳入180例患者，中位年龄为57岁，其中80%为初诊AML患者。54例（31%）存在FLT3-ITD突变，73例（42%）携带NPM1突变。符合2017年欧洲白血病网（European LeukemiaNet, ELN）预后分层标准的良好风险与中等风险患者分别占总患者的43%与34%。诱导治疗期间输注的红细胞（red blood cell, RBC）与血小板单位数的中位数分别为9单位与7单位。17例患者（9%）接受了冷沉淀输注，12例患者（7%）接受了新鲜冰冻血浆（fresh frozen plasma, FFP）输注。初始血红蛋白与血小板水平较低可预测红细胞（p<0.0001）与血小板输注量的增加。新鲜冰冻血浆输注与诱导治疗相关死亡率（42% vs 5%；p<0.0001）以及FLT3-ITD突变状态（72% vs 28%；p=0.004）显著相关。AB血型患者的平均总生存期优于O血型患者（4.1年 vs 2.8年；p=0.025）。多因素分析显示，输注新鲜冰冻血浆单位数[风险比（hazard ratio, HR）=4.23；95%置信区间（confidence interval, CI）：2.1~8.6；p<0.001]与红细胞单位数（HR=1.8；95%CI：1.2~2.8；p=0.008）增加均与不良生存结局显著相关。
结论：诱导治疗期间的输注需求对急性髓系白血病患者的临床转归具有关键性影响。