免疫调节剂来那度胺和沙利度胺治疗骨髓增生异常综合征：临床实践指南。
The immunomodulatory agents lenalidomide and thalidomide for treatment of the myelodysplastic syndromes: a clinical practice guideline.
机构信息
Hematology, St. Paul's Hospital and the University of British Columbia, Vancouver, Canada.
出版信息
Crit Rev Oncol Hematol. 2013 Feb;85(2):162-92. doi: 10.1016/j.critrevonc.2012.07.003. Epub 2012 Aug 15.
BACKGROUND
Myelodysplastic syndromes (MDS) are clonal disorders that result in cytopenias and risk of acute myeloid leukemia. Incidence increases with age and more diagnoses are expected with the aging population. Treatment includes red blood cell transfusion for anemia. The immunomodulatory agents (imids) thalidomide and lenalidomide may induce transfusion independence. This guideline systematically reviews evidence on imids to treat MDS and makes evidence-based recommendations.
METHODS
The literature and meeting abstracts were searched for phase 2-3 clinical trials. Data on efficacy, toxicity, and which patients benefit were extracted.
RESULTS
7019 citations on MDS management were identified. Thirteen publications and 9 meeting abstracts met eligibility criteria.
CONCLUSIONS
Lenalidomide is recommended as first line therapy in lower risk del5q MDS. There is insufficient evidence to recommend lenalidomide for treatment of higher risk del5q MDS or AML, or for any risk non-del5q MDS or AML. Combining lenalidomide with other agents is not recommended. Thalidomide is not recommended.
背景
骨髓增生异常综合征（MDS）是一种克隆性疾病，可导致血细胞减少和急性髓系白血病的风险。发病率随年龄增长而增加，随着人口老龄化，预计会有更多的诊断。治疗包括贫血时输血红细胞。免疫调节药物（imid）沙利度胺和来那度胺可能诱导输血独立性。本指南系统地回顾了 imid 治疗 MDS 的证据，并提出了循证建议。
方法
搜索了 2-3 期临床试验的文献和会议摘要。提取了疗效、毒性和哪些患者受益的数据。
结果
在 MDS 管理方面确定了 7019 条引文。有 13 篇出版物和 9 篇会议摘要符合入选标准。
结论
来那度胺被推荐为低危 del5q MDS 的一线治疗药物。没有足够的证据推荐来那度胺治疗高危 del5q MDS 或 AML，或治疗任何风险的非 del5q MDS 或 AML。不建议将来那度胺与其他药物联合使用。不推荐使用沙利度胺。
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