Analysis of clinical characteristics of 92 patients with paroxysmal nocturnal hemoglobinuria: A single institution experience in China

Abstract

Objectives: We performed a retrospective analysis to investigate the clinical characteristics and therapeutic strategies of Chinese paroxysmal nocturnal hemoglobinuria (PNH) patients, and assessed the efficacy and safety of glucocorticoid in PNH patients.

Methods: The clinical data of 92 PNH cases in our hospital were analyzed, including clinical manifestation, laboratory examination, treatment efficacy, and survival.

Results: The main clinical manifestations of these patients included hemoglobinuria, anemia, fatigue, dyspnea, headache, abdominal pain, and erectile dysfunction. Glucocorticoid is still the first-line treatment for PNH patients to control hemolytic attack, and the short-term remission rate (12 months) is 79.01% (64/81). Meanwhile, the overall survival (OS) of 10 years after diagnosis was estimated as 70.77% (46/65). Moreover, Cox proportional risk model for multivariate analysis showed that the increase in LDH multiple, thrombosis complications, and complicated with bone marrow failure were the independent adverse prognostic factors affecting the survival of PNH patients.

Conclusion: Paroxysmal nocturnal hemoglobinuria patients in mainland China have various clinical features, while lower incidences of thrombosis and renal damage. Thrombosis and bone marrow failure are two complications with worse prognosis.

Keywords: glucocorticoid; paroxysmal nocturnal hemoglobinuria; renal injury; thrombosis.

Figure 1

Glucocorticoid treatment efficacy in PNH patients. After 2‐4 wk treatment, the level of Hb increased significantly, while the levels of Ret, LDH, and TBIL were reduced, and the above hemolysis indicators were significantly different before and after treatment (A). The proportion of CD59‐negative neutrophils is positively related to the level of LDH in 81 PNH patients (r = .351, P = .0013) (B). The proportion of CD59‐negative neutrophils in 11 PNH patients with combined thrombosis is significantly higher than those without thrombosis (C) (P = .0028, ** represents P < .01, *** represents P < .001)

Figure 2

Survival rate in the cohort of the PNH patients. The overall survival (OS, %) in 10 y of all enrolled patients was showed (A), and then, the survival rates were observed according to the age (P = .026) (B), LDH increased times (P = .019) (C), combined with thrombosis (D) (P = .0001), combined with BMF (E) (P = .003), and the renal dysfunction (F) (P = .0001)