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骨髓增殖性肿瘤中的生活质量作为一个治疗靶点已逐渐成熟。

Quality of life in MPN comes of age as a therapeutic target.

作者信息

Scherber Robyn M, Geyer Holly L, Mesa Ruben A

机构信息

Mayo Clinic, 13400 E. Shea Blvd, Scottsdale, AZ, 85259, USA,

出版信息

Curr Hematol Malig Rep. 2014 Dec;9(4):324-30. doi: 10.1007/s11899-014-0239-9.

Abstract

BCR-ABL-negative myeloproliferative neoplasms include primary myelofibrosis, polycythemia vera, and essential thrombocythemia. Clonal stem cell proliferation and dysregulated JAK/STAT molecular pathways characterize these hematologic malignancies. Symptoms experienced by patients are heterogeneous including excessive and disabling fatigue, early satiety, anorexia, pruritus, bone pain, night sweats, cachexia, abdominal pain and discomfort, and cognitive complaints. Patients also experience impaired quality of life along with decreased overall survival. New targeted drug therapies, including JAK2 inhibitors, have demonstrated remarkable success in alleviating the myeloproliferative neoplasm (MPN) symptomatic burden, reducing splenomegaly and improving quality of life while offering overall survival benefit. Within the USA, FDA approval has only been granted to use JAK2 inhibitors in intermediate- to high-risk myelofibrosis. However, given that low-prognostic-scoring patients have been shown to have considerable symptomology, there is a possibility that lower-risk patients may benefit from therapy. More than ever, the need for accurate MPN symptom burden assessment and subsequent addition of targeted therapies is critical in the treatment of MPNs. This article discusses the role of MPN symptom burden and quality of life as therapeutic targets in the context of recent MPN clinical advances.

摘要

BCR-ABL阴性骨髓增殖性肿瘤包括原发性骨髓纤维化、真性红细胞增多症和原发性血小板增多症。克隆性干细胞增殖和JAK/STAT分子途径失调是这些血液系统恶性肿瘤的特征。患者经历的症状多种多样,包括过度且使人衰弱的疲劳、早饱、厌食、瘙痒、骨痛、盗汗、恶病质、腹痛和不适以及认知方面的主诉。患者的生活质量也受到损害,总体生存期缩短。包括JAK2抑制剂在内的新型靶向药物疗法已在减轻骨髓增殖性肿瘤(MPN)的症状负担、缩小脾肿大和改善生活质量方面取得显著成功,同时还能延长总体生存期。在美国,FDA仅批准在中高危骨髓纤维化中使用JAK2抑制剂。然而,鉴于低预后评分的患者已被证明有相当多的症状,低风险患者有可能从治疗中获益。如今,准确评估MPN症状负担并随后添加靶向疗法在MPN治疗中至关重要。本文在近期MPN临床进展的背景下讨论了MPN症状负担和生活质量作为治疗靶点的作用。

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