Lin Jie, Zhu Hongli, Li Suxia, Fan Hui, Lu Xuechun, Chang Cheng, Guo Bo, Zhai Bing
Department of Geriatric Hematology, Chinese People's Liberation Army General Hospital, Haidian, Beijing 100853, P.R. China.
Oncol Lett. 2013 Apr;5(4):1321-1324. doi: 10.3892/ol.2013.1139. Epub 2013 Jan 18.
The incidence of acute myelogenous leukemia (AML) in patients over 80 years old is >20 times greater than that observed in younger patients. Previously, no standard treatment protocol for elderly patients with AML existed, however the development of hypomethylating agents, including decitabine, has brought about promising results in AML. In the present study, we report on the usage of a lower than routine dosage of decitabine in patients over 80 years old with AML. Since January 2010, 5 patients diagnosed with AML over the age of 80 years old received treatment with decitabine in our hospital. Decitabine was administered at a dose of 10-15 mg/m and repeated every other day for a total of 5 days. This cycle was repeated for ∼6 weeks. The 5 patients received a total of 19 cycles of treatment with decitabine. No patient achieved complete or partial remission. An antileukemic effect was observed in 25% of courses (3/12). An increase in platelet count of >20×10/l was observed in 26.3% (5/19) of cycles compared with previous treatment. An increase in hemoglobin concentration of >20 g/l was observed in 36.8% (7/19) of cycles in comparison to previous treatment, four of which achieved normal hemoglobin levels. One patient became red blood cell transfusion-independent. The median survival time was 19.8±4.8 months. Survival time from decitabine administration to mortality was 13.2±5.1 months. The main side-effect was bone marrow suppression with grade III-IV thrombocytopenia, grade III-IV leukocytopenia, grade III-IV neutropenia and anemia accounting for 94.7% (18/19), 47.4% (9/19), 89.5% (17/19) and 21.1% (4/19), respectively. Severe infection or bleeding was not observed and no patient stopped treatment due to adverse effects. In conclusion, extremely low-dose decitabine may be used safely in elderly patients and achieved longer survival times than reported previously in AML patients aged 80 and above. It is suggested that complete remission may not be the primary objective, while improvement of quality of life may be a better choice in AML patients over 80 years old. The cases observed in our study were limited, so more cases are required for further study.
80岁以上患者急性髓系白血病（AML）的发病率比年轻患者高20倍以上。以前，老年AML患者没有标准治疗方案，然而，包括地西他滨在内的低甲基化药物的开发在AML治疗中取得了令人鼓舞的结果。在本研究中，我们报告了80岁以上AML患者低于常规剂量地西他滨的使用情况。自2010年1月以来，我院有5例80岁以上诊断为AML的患者接受了地西他滨治疗。地西他滨的给药剂量为10 - 15mg/m²，每隔一天重复给药，共5天。此周期重复约6周。这5例患者共接受了19个周期的地西他滨治疗。没有患者达到完全缓解或部分缓解。在25%的疗程（3/12）中观察到抗白血病作用。与之前治疗相比，26.3%（5/19）的周期中血小板计数增加>20×10⁹/L。与之前治疗相比，36.8%（7/19）的周期中血红蛋白浓度增加>20g/L，其中4例达到正常血红蛋白水平。1例患者不再依赖红细胞输血。中位生存时间为19.8±4.8个月。从给予地西他滨到死亡的生存时间为13.2±5.1个月。主要副作用是骨髓抑制，III - IV级血小板减少、III - IV级白细胞减少、III - IV级中性粒细胞减少和贫血分别占94.7%（18/19）、47.4%（9/19）、89.5%（17/19）和21.1%（4/19）。未观察到严重感染或出血，也没有患者因不良反应而停止治疗。总之，极低剂量地西他滨可在老年患者中安全使用，并且与之前报道的80岁及以上AML患者相比，生存时间更长。建议完全缓解可能不是主要目标，而改善生活质量可能是80岁以上AML患者更好的选择。我们研究中观察的病例有限，因此需要更多病例进行进一步研究。
