Department of Internal Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria.
Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna, Austria.
Am J Hematol. 2016 Dec;91(12):1239-1245. doi: 10.1002/ajh.24560. Epub 2016 Nov 8.
Although it is generally appreciated that a subset of elderly patients with acute myeloid leukemia (AML) may benefit from intensive consolidation, little is known about variables predicting such benefit. We analyzed 192 consecutive patients with de novo AML aged ≥60 years who were treated with intensive chemotherapy. About 115 patients (60%) achieved complete hematologic remission (CR). Among several parameters, the karyotype was the only independent variable predicting CR (P < 0.05). About 92% (105/115) of the CR-patients received up to four consolidation cycles of intermediate dose ARA-C. Median continuous CR (CCR) and disease-free survival (DFS) were 1.3 and 1.1 years, respectively. CCR, DFS, and survival at 5 years were 23%, 18%, and 15%, respectively. Only karyotype and mutated NPM1 (NPM1mut) were independent predictors of survival. NPM1mut showed a particular prognostic impact in patients with normal (CN) or non-monosomal (Mkneg) karyotype by Haemato-Oncology Foundation for Adults in the Netherlands (HOVON)-criteria, or intermediate karyotype by Southwest Oncology Group (SWOG)-criteria. The median CCR was 0.94, 1.6, 0.9, and 0.5 years for core-binding-factor, CN/Mkneg-NPM1mut, CN/Mkneg-NPM1-wild-type AML, and AML with monosomal karyotype, respectively, and the 5-year survival was 25%, 39%, 2%, and 0%, respectively (P < 0.05). Similar results (0.9, 1.5, 0.9, and 0.5 years) were obtained using modified SWOG criteria and NPM1 mutation status (P < 0.05). In summary, elderly patients with CN/Mkneg-NPM1mut or CBF AML can achieve long term CCR when treated with intensive induction and consolidation therapy whereas most elderly patients with CN/Mkneg-NPM1wt or Mkpos AML may not benefit from intensive chemotherapy. For these patients either hematopoietic-stem-cell-transplantation or alternative treatments have to be considered. Am. J. Hematol. 91:1239-1245, 2016. © 2016 Wiley Periodicals, Inc.
虽然人们普遍认为，一部分老年急性髓系白血病（AML）患者可能受益于强化巩固治疗，但关于预测这种获益的变量知之甚少。我们分析了 192 例年龄≥60 岁的初治 AML 患者，他们接受了强化化疗。约 115 例患者（60%）达到完全血液学缓解（CR）。在几个参数中，核型是唯一独立预测 CR 的变量（P<0.05）。约 92%（105/115）的 CR 患者接受了多达 4 个中等剂量 ARA-C 的巩固周期。中位持续 CR（CCR）和无病生存（DFS）分别为 1.3 年和 1.1 年。5 年时的 CCR、DFS 和生存率分别为 23%、18%和 15%。仅核型和突变型 NPM1（NPM1mut）是生存的独立预测因素。NPM1mut 在荷兰血液肿瘤学成人研究组（HOVON）-标准下核型正常（CN）或非单体（Mkneg）或中间核型，或西南肿瘤协作组（SWOG）-标准下核型异常的患者中具有特殊的预后影响。核型为核心结合因子、CN/Mkneg-NPM1mut、CN/Mkneg-NPM1-wild-type AML 和单体核型 AML 的患者中位 CCR 分别为 0.94、1.6、0.9 和 0.5 年，5 年生存率分别为 25%、39%、2%和 0%（P<0.05）。使用改良的 SWOG 标准和 NPM1 突变状态，也获得了类似的结果（0.9、1.5、0.9 和 0.5 年）（P<0.05）。总之，接受强化诱导和巩固治疗的 CN/Mkneg-NPM1mut 或 CBF AML 老年患者可以获得长期 CCR，而大多数 CN/Mkneg-NPM1wt 或 Mkpos AML 老年患者可能无法从强化化疗中获益。对于这些患者，要么考虑造血干细胞移植，要么考虑替代治疗。Am J Hematol. 91:1239-1245, 2016. © 2016 Wiley Periodicals, Inc.
