Purpose: To determine associations between allogeneic blood transfusion (ABT) during the intensive induction phase of therapy and prognostic effect in a real-world cohort of pediatric patients with acute lymphoblastic leukemia (ALL).Methods: A total of 749 pediatric patients who were diagnosed with ALL were enrolled in this study by using a single-center retrospective cohort study method from February 2008 to May 2022.Results: Among the ABT patients, 711 (94.9%) children were transfused with packed red blood cells (PRBCs), 434 (57.9%) with single-donor platelets (SDPs), and 196 (26.2%) with fresh frozen plasma (FFP). Our multivariate analysis demonstrated that FFP transfusion was the unique independent factor that affected both relapse-free survival (RFS) and overall survival (OS). The transfusion of FFP was significantly associated with higher age (p< 0.001), being more likely to receive SCCLG-ALL-2016 protocol (p< 0.001), higher proportion of more than 25 blood product transfusions, more PRBC transfusion (p< 0.001), and higher D33-MRD-positive rates (p= 0.013). Generalized additive models and threshold effect analysis using piece-wise linear regression were applied to identify the cut-off value of 25 mL/kg for average FFP transfusion. K-M survival analysis further confirmed that average FFP transfusion > 25 mL/kg was an independent adverse indicator of inferior outcome in terms of RFS (p= 0.027) and OS (p= 0.033).Conclusions: In blood products, only FFP supplement is closely related to the prognosis of childhood ALL. During the intensive induction phase, the indications of FFP transfusion should be strictly grasped, and the total amount of FFP should be controlled and kept below 25 mL/kg.
目的：探讨真实世界儿童急性淋巴细胞白血病（ALL）患者在强化诱导治疗期间接受异体输血（ABT）与预后的关联性。 方法：采用单中心回顾性队列研究方法，纳入2008年2月至2022年5月期间确诊的749例ALL患儿。 结果：在ABT患者中，711例（94.9%）输注了浓缩红细胞（PRBCs），434例（57.9%）输注了单采血小板（SDPs），196例（26.2%）输注了新鲜冰冻血浆（FFP）。多变量分析显示，FFP输注是影响无复发生存期（RFS）和总生存期（OS）的唯一独立因素。FFP输注与较高年龄（p<0.001）、更可能接受SCCLG-ALL-2016方案（p<0.001）、输血制品超过25次的比例更高、更多PRBC输注（p<0.001）以及较高的D33-MRD阳性率（p=0.013）显著相关。通过广义加性模型和分段线性回归的阈值效应分析，确定FFP平均输注量的临界值为25 mL/kg。K-M生存分析进一步证实，FFP平均输注量>25 mL/kg是RFS（p=0.027）和OS（p=0.033）不良预后的独立危险因素。 结论：在血液制品中，仅FFP补充与儿童ALL的预后密切相关。在强化诱导治疗期间，应严格掌握FFP输注指征，控制FFP总输注量并保持在25 mL/kg以下。
肿瘤(癌症)患者之家