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I. Abou Dalle et al.
instances, secondary myeloid malignancies.5,6 There is an unmet need to develop strategies aimed at selectively protecting HSC from the damaging effects of chemother- apy, and maintaining the HSC pool especially for cancer survivors. Growing evidence suggests that the luteiniz- ing hormone/choriogonadotropin receptor (LHCGR) is expressed on human HSC and that LH is implicated in HSC self-renewal.7,8 In preclinical murine models, LH suppression using an LH-releasing hormone (LHRH) antagonist improved hematopoietic recovery after
Table 1. Baseline characteristics.
Characteristics Before propensity matching N (%), median [range]
chemotherapy or lethal dose radiation.9-11 Leuprolide, a gonadotropin-releasing hormone (GnRH) agonist, has been widely used in cancer patients during intensive chemotherapy and allogeneic stem cell transplantation in order to reduce the incidence of abnormal uterine bleed- ing and for fertility preservation.12-14 In this study, we conducted a retrospective analysis aimed at evaluating the effect of leuprolide on hematopoietic recovery fol- lowing intensive cytotoxic chemotherapy in acute leukemia.
After propensity matching N (%), median [range]
Leuprolide Control P
N 66 388 64 128
A. AML cohort
Leuprolide
33 [19-54]
Control P
35 [18-56] 0.7 1
Age, years ECOG PS
33 [19-54]
47 [18-56]
<0.001 0.4
6.6 [0.5-390] 0.7
42.0 [1-676] 0.8 920 [200-14,701] 0.1 120 (31) 0.8 0.1
78 (20) 194 (50) 116 (30)
0-1
≥2 6(9) 51(13) 6(9) 11(9)
WBC x109/L Plt x109/L LDH UI/L AMML/AMOL ELN Risk
Favorable Intermediate Adverse
39 (31) 53 (41) 36 (28)
58 (91)
7.1 [0.7-160]
38.5 [3-271] 786 [297-18,336] 22 (33)
21 (32) 27 (41) 18 (27)
326 (87)
58 (91)
7.2 [0.7-160] 37 [3-271] 789 [297-18,336] 22 (34)
21 (33) 26 (41) 17 (26)
117 (91)
6.6 [0.5-80] 0.6
35.5 [2-575] 0.7 886 [322-14,701] 0.1 31 (24) 0.2 0.9
Treatment*
Doublet
Triplet
Other 6(9) 12(3) 6(9) 7(6)
0.04
0.02 14 (22) 10 (9)
0.04 20 (31) 37 (29) 0.7
49 98
Age, years
ECOGPS 1 1
FLT3 Inhibitor Transplant
B. ALL cohort
N
14 (21) 41 (11) 27 (41) 110 (28)
65 192
0.009
23 (35) 37 (56)
205 (53) 171 (44)
22 (35) 36 (56)
54 (42) 67(52)
0.4
31 [18-49] 41 [18-56]
<0.001 32 [18-49] 32 [18-55] 0.6
0-1
HyperCVAD
AugBFM
Transplant
50 (85)
9 (15)
5.8 [0.6-316] 51 [0-495] 1,096 [284-28,015] 32 (54)
58 (89)
7 (11)
43 (66)
18 (28)
24 (37)
145 (84)
28 (16)
5.4 [0.5-420] 29 [2-393] 1,256 [238-37,602] 87 (50)
178 (93)
14 (7)
169 (88)
23 (12)
37 (19)
42 (86) 7 (14)
0.9 7.6 [0.6-316] 0.1 54 [0-495]
0.5 1,109 [284-28,015] 0.6 25 (51)
0.4 44 (90) 5 (10)
85 (87)
13 (13)
7 [0.6-420] 0.5 50 [5-395] 0.8
1,125 [268-37,602] 0.8 47 (48) 0.7
89 (91) 1 9 (9)
0.07
19 (19) 0.02
≥2
WBC x109/L Plt x109/L LDH UI/L Adverse CG** B-ALL
T-ALL Treatment
0.001
34 (69)
13 (27)
83 (85)
15 (15)
0.006 19 (39)
Propensity score matching included all the above baseline characteristics. * Doublet chemotherapy: idarubicin and cytarabine (IA); triplet chemotherapy: IA plus a nucleoside analog (i.e., cladribine, clofarabine, or fludarabine). **Adverse cytogenetics: complex karyotype (≥ 5 abnormalities) t(9;22), t(4;11), and low hypodiploidy/near-triploidy. AML: acute myeloid leukemia; ALL: acute lymphoblastic leukemia; N: number; ECOG PS: Eastern Cooperative Oncology Group performance status; WBC: white blood cell; Plt: platelet count; LDH: lactate dehydrogenase level; AMML/AMOL: acute myelomonocytic leukemia and monocytic leukemia; HyperCVAD: hyperfractionated cyclophosphamide, vin- cristine, adriamycin, dexamethasone; AugBFM: Augmented BFM regimen; ELN: European LeukemiaNet.
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