Gemuenden Cornelia, Benz Rudolf, Senn Oliver, Goede Jeroen S, Manz Markus G, Gerber Bernhard
Division of Hematology, University Hospital and University of Zurich, Zurich, Switzerland.
Department of Internal Medicine, Kantonsspital Munsterlingen, Munsterlingen, Switzerland.
Clin Lymphoma Myeloma Leuk. 2015 Dec;15(12):811-5. doi: 10.1016/j.clml.2015.09.003. Epub 2015 Sep 25.
Azacitidine is a therapeutic alternative to low-dose cytarabine in patients with acute myeloid leukemia (AML) who are unfit for intensive chemotherapy.
We retrospectively analyzed all AML patients treated with azacitidine at the University Hospital Zurich and the Kantonsspital Munsterlingen between January 2005 and December 2011. The primary end point was overall survival (OS).
Thirty-eight patients were included in the analysis. Twenty-one (55%) patients had newly diagnosed AML, 14 (37%) had relapsed AML, and 3 (8%) underwent bridging therapy before allogeneic stem-cell transplantation. Age at diagnosis was 72 years in the newly diagnosed cohort and 58 years in the relapsed cohort, 19 (50%) patients were female, 20 (53%) patients were transfusion dependent, and bone marrow blast count was 43% (interquartile range, 26-80). Most patients (58%) had poor or very poor risk AML. Patients received a median (range) of 7 (3-13) therapy cycles. The median (range) OS in the newly diagnosed and previously treated patient groups were 308 (175-580) days and 346 (293-628) days, respectively (P = .94). Median OS in the 3 patients treated before allogeneic stem-cell transplantation has not been reached. Sixty-day mortality was 7.9%, with no difference between the 2 groups. Ongoing or increasing transfusion dependency was associated with adverse outcome (hazard ratio, 3.09; 95% confidence interval, 1.29-7.37, P = .011).
Treatment with azacitidine led to a median OS of 10 months in both a previously untreated and a previously treated frail AML patient cohort. A positive effect in transfusion dependency was observed in 29% of these patients and was associated with better survival.
对于不适合接受强化化疗的急性髓系白血病（AML）患者，阿扎胞苷是小剂量阿糖胞苷的一种治疗替代方案。
我们回顾性分析了2005年1月至2011年12月期间在苏黎世大学医院和明斯特林根州立医院接受阿扎胞苷治疗的所有AML患者。主要终点是总生存期（OS）。
38例患者纳入分析。21例（55%）患者为新诊断的AML，14例（37%）为复发的AML，3例（8%）在异基因干细胞移植前接受了桥接治疗。新诊断队列的诊断年龄为72岁，复发队列的诊断年龄为58岁，19例（50%）患者为女性，20例（53%）患者依赖输血，骨髓原始细胞计数为43%（四分位间距，26 - 80）。大多数患者（58%）的AML风险为中危或高危。患者接受的治疗周期中位数（范围）为7（3 - 13）个。新诊断患者组和既往治疗患者组的OS中位数（范围）分别为308（175 - 580）天和346（293 - 628）天（P = 0.94）。3例在异基因干细胞移植前接受治疗的患者的OS中位数尚未达到。60天死亡率为7.9%，两组之间无差异。持续或增加的输血依赖性与不良结局相关（风险比，3.09；95%置信区间，1.29 - 7.37，P = 0.011）。
在既往未治疗和既往治疗的体弱AML患者队列中，阿扎胞苷治疗的OS中位数均为10个月。在这些患者中，29%观察到对输血依赖性有积极影响，且与更好的生存相关。
