Article Dans Une Revue Annals of Hematology Année : 2023

Benefits of dexamethasone on early outcomes in patients with acute myeloid leukemia with hyperleukocytosis: a propensity score matched analysis

Marco Cerrano
  • Fonction : Auteur
Sylvie Chevret
  • Fonction : Auteur
Emmanuel Raffoux
  • Fonction : Auteur
Florence Rabian
  • Fonction : Auteur
Sandrine Valade
  • Fonction : Auteur
Virginie Lemiale
  • Fonction : Auteur
Nicolas Boissel
  • Fonction : Auteur
Elie Azoulay
Etienne Lengliné

Résumé

Hyperleukocytosis is associated with a significant early mortality rate in patients with acute myeloid leukemia (AML). To date, no controlled trial has ever evaluated a strategy to reduce this risk, and the initial management of these patients remains heterogeneous worldwide. The aim of the present study was to evaluate the influence of a short course of intravenous dexamethasone on the early outcomes of patients with hyperleukocytic AML with white blood cell (WBC) count above 50 × 109/L. Clinical and biological data of all consecutive patients (1997-2017) eligible for intensive chemotherapy from a single center were retrospectively collected. A total of 251 patients with a median age of 51 years and a median WBC count of 120 × 109/L were included, 95 of whom received dexamethasone. Patients treated with dexamethasone had higher WBC count and a more severe disease compared with those who did not, and they presented more often with leukostasis and hypoxemia, resulting in a more frequent need for life-sustaining therapies (p < 0.001). To account for these imbalances, patients were compared after adjusting for a propensity score, which included all variables with a prognostic influence in the overall cohort. In the matched cohort, dexamethasone was associated with lower early death (OR = 0.34, p = 0.0026) and induction failure rate (OR = 0.44, p = 0.02) and better overall survival (HR = 0.60, p = 0.011), with no impact on relapse risk (cHR = 0.73, p = 0.39). The overall survival benefit was confirmed among all tested subgroups. This study suggests that dexamethasone administration is safe and associated with a lower risk of induction mortality in patients with hyperleukocytic AML and deserves prospective evaluation.

Dates et versions

hal-04089839 , version 1 (05-05-2023)

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Citer

Marco Cerrano, Sylvie Chevret, Emmanuel Raffoux, Florence Rabian, Marie Sébert, et al.. Benefits of dexamethasone on early outcomes in patients with acute myeloid leukemia with hyperleukocytosis: a propensity score matched analysis. Annals of Hematology, 2023, 102 (4), pp.761-768. ⟨10.1007/s00277-023-05119-3⟩. ⟨hal-04089839⟩
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