柔红霉素治疗失败后的骨髓增生异常综合征和慢性粒单核细胞白血病患者的结局。

Outcomes of patients with myelodysplatic syndrome and chronic myelomonocytic leukemia post clofarabine failure.

机构信息

Lebanese American University, University Medical Center, Beirut, Lebanon.

MDACC, Houston, TX, USA.

出版信息

Ther Adv Hematol. 2014 Apr;5(2):29-34. doi: 10.1177/2040620713519742.

DOI:10.1177/2040620713519742

PMID:24688752

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3949300/

Abstract

BACKGROUND

The outcome of patients with myelodysplastic syndrome (MDS) and chronic myelomonocytic leukemia (CMML) post clofarabine is unknown.

METHODS

We reviewed 109 patients with MDS or CMML with a median age of 67 years, treated with a clofarabine-based chemotherapy as frontline (n = 38) or salvage (n = 71) therapy. A total of 58 (53%) patients received salvage therapy after clofarabine failure: 13 allogeneic stem cell transplant (ASCT), 18 high-dose cytarabine-containing regimen, 10 hypomethylating agents and 17 investigational treatments.

RESULTS

Eight patients achieved complete remission (CR) and three had stable disease for an overall response rate of 19%. With a median follow-up of 3 months from clofarabine failure, 12 patients (11%) remained alive, 5 remain in CR, 4 of them after ASCT. The median overall survival post clofarabine failure was 4 months with a 1-year survival rate of 23%.

CONCLUSIONS

This outcome is predictable, with patients with high-risk disease at the time of clofarabine failure having the worse survival. To date, patients with MDS continue to have a short survival after failure of all available therapies. Ultimately, patients who are candidates for additional treatments should be offered novel approaches. In conclusion, the outcome of patients with MDS and CMML post clofarabine failure is poor. The pattern is similar to patients with MDS post hypomethylating agent failure and predictable using University of Texas M. D. Anderson Cancer Center global scoring system.

摘要

背景

接受克拉屈滨治疗后的骨髓增生异常综合征（MDS）和慢性粒单核细胞白血病（CMML）患者的结局尚不清楚。

方法

我们回顾了 109 例 MDS 或 CMML 患者的临床资料，这些患者的中位年龄为 67 岁，接受克拉屈滨为基础的化疗作为一线（n = 38）或挽救性（n = 71）治疗。共有 58 例（53%）患者在克拉屈滨治疗失败后接受挽救性治疗：13 例异基因造血干细胞移植（ASCT），18 例高剂量阿糖胞苷方案，10 例低甲基化药物和 17 例研究性治疗。

结果

8 例患者达到完全缓解（CR），3 例患者疾病稳定，总缓解率为 19%。克拉屈滨治疗失败后中位随访 3 个月，12 例（11%）患者存活，5 例患者持续缓解，其中 4 例在 ASCT 后。克拉屈滨治疗失败后的中位总生存期为 4 个月，1 年生存率为 23%。

结论

该结果是可预测的，克拉屈滨治疗失败时患有高危疾病的患者生存情况更差。迄今为止，所有可用治疗方法失败后，MDS 患者的生存时间仍然较短。最终，应向有条件接受额外治疗的患者提供新的治疗方法。总之，克拉屈滨治疗失败后的 MDS 和 CMML 患者的预后较差。该模式与低甲基化药物治疗失败后的 MDS 患者相似，可使用德克萨斯大学 M.D.安德森癌症中心全球评分系统进行预测。