Department of Leukemia, University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA.
Clin Lymphoma Myeloma Leuk. 2010 Jun;10(3):205-10. doi: 10.3816/CLML.2010.n.032.
To our knowledge, the feasibility of therapy with hypomethylating agents (HAs) in patients with renal insufficiency (RI) has not been examined.
We reviewed 41 patients with a diagnosis of acute myeloid leukemia (n = 17), myelodysplastic syndromes (n = 15), and chronic myelomonocytic leukemia (n = 9) who had RI and were receiving therapy with azacitidine or decitabine. The median number of administered cycles was 3. Most patients (39; 95%) received a standard dose of the drugs at the initiation of therapy. Nine patients (22%) required treatment interruptions or discontinuation, and 10 patients (24%) required dose reductions.
The overall response rate was 63%, and 4 patients (10%) achieved a complete response. Twenty patients (51%) experienced grade 3 or 4 myelosuppression-related toxicities. Hospitalization was required in 68% of the patients. Among 12 patients with an estimated glomerular filtration rate of 29 mL per minute or less, 6 required dose reductions attributable to myelosuppression (n = 3) or to worsening renal function (n = 3). The overall survival (OS) at 18 months was 12%, and the median OS was 8.6 months.
The use of HA in patients with RI is feasible, but is associated with a higher incidence of toxicity. Dose adjustments and the use of growth factor may be necessary for some patients.
据我们所知，肾不全（RI）患者使用低甲基化药物（HA）治疗的可行性尚未得到检验。
我们回顾了 41 名诊断为急性髓系白血病（n = 17）、骨髓增生异常综合征（n = 15）和慢性粒单核细胞白血病（n = 9）且接受阿扎胞苷或地西他滨治疗的 RI 患者。中位数接受了 3 个周期的治疗。大多数患者（39 例，95%）在开始治疗时接受了标准剂量的药物。9 例（22%）需要中断或停止治疗，10 例（24%）需要减少剂量。
总体缓解率为 63%，4 例（10%）患者达到完全缓解。20 例（51%）患者出现 3 级或 4 级骨髓抑制相关毒性。68%的患者需要住院治疗。在估计肾小球滤过率为 29 毫升/分钟或更低的 12 例患者中，有 6 例因骨髓抑制（n = 3）或肾功能恶化（n = 3）需要减少剂量。18 个月的总生存率（OS）为 12%，中位 OS 为 8.6 个月。
HA 在 RI 患者中是可行的，但与更高的毒性发生率相关。对于一些患者，可能需要调整剂量和使用生长因子。
