Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, CRB1 Building, Room 186, Baltimore, MD 21287, USA.
Expert Rev Hematol. 2013 Oct;6(5):539-42. doi: 10.1586/17474086.2013.827097. Epub 2013 Oct 4.
Myelodysplastic syndromes (MDS) include a group of hematopoietic malignancies characterized by dysplastic changes, ineffective hematopoiesis and variable risk of leukemic progression. At diagnosis, 86% of MDS patients are ≥60 years. Azacitidine, the only drug that prolongs life in high-risk (HR)-MDS patients, adds a median of only 9.5 months to life. Allogeneic stem cell transplantation (alloSCT) remains the only potentially curative approach. Despite recent improvements including use of reduced intensity conditioning (RIC) that decrease transplant-related mortality, alloSCT continues to be used rarely in elderly MDS. There is paucity of data regarding outcomes of RIC alloSCT in elderly MDS patients, especially in direct comparison with azanucleosides. In this paper, the authors discuss the recent Markov decision analysis by Koreth et al. in which investigators demonstrated superior survival of patients with HR-MDS aged 60-70 years who underwent RIC alloSCT in comparison with those who were treated with azanucleosides.
骨髓增生异常综合征（MDS）包括一组造血恶性肿瘤，其特征为发育不良改变、无效造血和白血病进展的不同风险。在诊断时，86%的 MDS 患者年龄≥60 岁。阿扎胞苷是唯一能延长高危（HR）-MDS 患者生命的药物，中位生存期仅延长 9.5 个月。异基因造血干细胞移植（alloSCT）仍然是唯一有潜在治愈作用的方法。尽管最近有所改善，包括使用降低强度的预处理（RIC）降低移植相关死亡率，但 alloSCT 在老年 MDS 患者中仍然很少使用。关于 RIC alloSCT 在老年 MDS 患者中的结果的数据很少，特别是与氮杂核苷的直接比较。在本文中，作者讨论了 Koreth 等人最近的马尔可夫决策分析，该分析表明，60-70 岁 HR-MDS 患者接受 RIC alloSCT 治疗的生存率优于接受氮杂核苷治疗的患者。
