治疗慢性髓性白血病的伊马替尼传播中的年龄差距。
Age disparity in the dissemination of imatinib for treating chronic myeloid leukemia.
机构信息
New Mexico Tumor Registry, University of New Mexico Health Sciences Center, Albuquerque, NM 87131, USA.
出版信息
Am J Med. 2010 Aug;123(8):764.e1-9. doi: 10.1016/j.amjmed.2010.03.018.
BACKGROUND
Imatinib is a highly effective treatment for chronic myeloid leukemia. It was approved by the Food and Drug Administration in 2001 and thereafter rapidly became front-line therapy. This study characterized the prevailing chronic myeloid leukemia therapies in the United States and assessed the impact of imatinib on chronic myeloid leukemia survival and mortality rates in the general population.
METHODS
Investigators with the National Cancer Institute's Patterns of Care study reviewed medical records and queried physicians regarding therapy for 423 patients with chronic myeloid leukemia diagnosed in 2003 who were randomly selected from cancer registries in the Surveillance, Epidemiology, and End Results Program. Characteristics associated with the receipt of imatinib were documented, as were survival differences between those who received imatinib and those who did not. Population-based data were used to assess chronic myeloid leukemia survival and mortality rates in time periods before and after the introduction of imatinib.
RESULTS
Imatinib was administered to 76% of patients in the Patterns of Care study. Imatinib use was inversely associated with age: 90%, 75%, and 46% for patients ages 20 to 59 years, 60 to 79 years, and 80 or more years, respectively. Elderly patients who received imatinib survived significantly longer than those who did not. After adjusting for age, imatinib use did not vary significantly by race/ethnicity, socioeconomic status, urban/rural residence, presence of comorbid conditions, or insurance status. Overall, chronic myeloid leukemia survival in the Surveillance, Epidemiology, and End Results population improved, and mortality in the United States declined dramatically during the period when imatinib became widely available; these improvements diminished with increasing age.
CONCLUSION
Age disparities in treatment with imatinib likely contributed to worse survival for many elderly patients with chronic myeloid leukemia.
背景
伊马替尼是一种治疗慢性髓性白血病的高效药物。它于 2001 年获得美国食品药品监督管理局批准，此后迅速成为一线治疗药物。本研究旨在描述美国目前慢性髓性白血病的治疗方法，并评估伊马替尼对普通人群慢性髓性白血病生存率和死亡率的影响。
方法
国家癌症研究所的Patterns of Care 研究的调查人员查阅了医疗记录，并向医生询问了 2003 年随机从监测、流行病学和最终结果计划中的癌症登记处中选择的 423 名慢性髓性白血病患者的治疗方法。记录了与接受伊马替尼治疗相关的特征，以及接受和未接受伊马替尼治疗的患者之间的生存差异。利用基于人群的数据评估了伊马替尼问世前后慢性髓性白血病的生存率和死亡率。
结果
Patterns of Care 研究中有 76%的患者接受了伊马替尼治疗。伊马替尼的使用与年龄呈负相关：年龄在 20 至 59 岁、60 至 79 岁和 80 岁及以上的患者中，分别有 90%、75%和 46%接受了伊马替尼治疗。接受伊马替尼治疗的老年患者的生存时间明显长于未接受治疗的患者。调整年龄后，种族/族裔、社会经济地位、城乡居住、合并症和保险状况等因素对伊马替尼的使用无显著差异。总体而言，在伊马替尼广泛应用期间，监测、流行病学和最终结果人群中的慢性髓性白血病生存率提高，美国的死亡率显著下降；随着年龄的增长，这些改善的效果减弱。
结论
伊马替尼治疗中的年龄差异可能导致许多老年慢性髓性白血病患者的生存状况较差。
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