Department of Biomedical Sciences and Human Oncology, Section of Internal Medicine and Clinical Oncology, University of Bari Medical School, Bari, Italy.
Clin Interv Aging. 2009;4:413-23. doi: 10.2147/cia.s5203. Epub 2009 Nov 18.
Most patients with myelodysplastic syndromes (MDS) are elderly (median age range 65 to 70 years); as a consequence, the incidence and prevalence of these diseases are rising as the population ages. Physicians are often uncertain about how to identify patients who may benefit from specific treatment strategies. The International Prognostic Scoring System is a widely used tool to assess the risk of transformation to leukemia and to guide treatment decisions, but it fails to take into account many aspects of treating elderly patients, including comorbid illnesses, secondary causes of MDS, prior therapy for MDS, and other age-related health, functional, cognitive, and social problems that affect the outcome and managing of myelodysplastic symptoms. Patients with low-risk disease traditionally have been given only best supportive care, but evidence is increasing that treatment with novel non-conventional drugs such as lenalidomide or methyltransferase inhibitors may influence the natural history of the disease and should be used in conjunction with supportive-care measures. Supportive care of these patients could also be improved in order to enhance their quality of life and functional performance. Elderly patients commonly have multiple medical problems and use medications to deal with these. In addition, they are more likely to have more than one health care provider. These factors all increase the risk of drug interactions and the consequent treatment of toxicities. Manifestations of common toxicities or illnesses may be more subtle in the elderly, owing to age-associated functional deficits in multiple organ systems. Particularly important to the elderly MDS patient is the age-related decline in normal bone marrow function, including the diminished capacity of response to stressors such as infection or myelosuppressive treatments. Through the integration of geriatric and oncological strategies, a personalized approach toward this unique population may be applied. As with many diseases in the elderly, reliance on family members or friends to maintain the prescribed treatments, including travel to and from appointments, may place additional stressors on the patient and his/her support network. Careful evaluation and knowledge of functional status, ability to tolerate treatments, effect of disease progression, and general overall health conditions can provide the best opportunity to support these patients. Immediate assessment of daily living activities may detect deficiencies or deficits that often require early interventions.
大多数骨髓增生异常综合征（MDS）患者为老年人（中位年龄范围为 65 岁至 70 岁）；因此，随着人口老龄化，这些疾病的发病率和患病率正在上升。医生通常不确定如何识别可能受益于特定治疗策略的患者。国际预后评分系统是一种广泛用于评估向白血病转化风险和指导治疗决策的工具，但它没有考虑到治疗老年患者的许多方面，包括合并症、MDS 的继发原因、MDS 的先前治疗以及其他与年龄相关的健康、功能、认知和社会问题，这些问题会影响 MDS 症状的结果和管理。传统上，低危疾病患者仅接受最佳支持治疗，但越来越多的证据表明，使用新型非传统药物（如来那度胺或甲基转移酶抑制剂）治疗可能会影响疾病的自然史，并且应与支持性护理措施结合使用。为了提高生活质量和功能表现，也可以改善这些患者的支持性护理。老年患者通常有多种医疗问题，并使用药物来解决这些问题。此外，他们更有可能有不止一个医疗保健提供者。这些因素都会增加药物相互作用的风险和随之而来的毒性治疗。由于多个器官系统的年龄相关功能缺陷，常见毒性或疾病的表现可能在老年人中更为微妙。对于老年 MDS 患者特别重要的是，与年龄相关的正常骨髓功能下降，包括对感染或骨髓抑制治疗等应激源的反应能力下降。通过整合老年病学和肿瘤学策略，可以针对这一独特人群采用个性化方法。与老年人的许多疾病一样，依赖家庭成员或朋友来维持规定的治疗，包括往返预约的旅行，可能会给患者及其支持网络带来额外的压力。仔细评估和了解功能状态、耐受治疗的能力、疾病进展的影响以及总体健康状况，可以为支持这些患者提供最佳机会。对日常生活活动的即时评估可以发现经常需要早期干预的缺陷或不足。
