DeZern Amy E, Zeidan Amer M, Barnard John, Hand Wesley, Al Ali Najla, Brown Francis, Zimmerman Cassie, Roboz Gail J, Garcia-Manero Guillermo, Steensma David P, Komrokji Rami S, Sekeres Mikkael A
a Department of Oncology , Sidney Kimmel Cancer Center , Baltimore , MD , USA.
b Yale Cancer Center, Yale University , New Haven , CT , USA.
Leuk Lymphoma. 2017 Jun;58(6):1325-1331. doi: 10.1080/10428194.2016.1246726. Epub 2016 Oct 24.
First-line therapy for higher-risk myelodysplastic syndromes (MDS) includes decitabine (DAC) or azacitidine (AZA). Variables have not identified differential response rates between these. We assessed the influence of patient sex on outcomes including overall survival (OS) in 642 patients with higher-risk MDS treated with AZA or DAC. DAC-treated patients (35% of females, 31% of males) had marginally better OS than AZA-treated patients (p = .043), (median OS of 18.7 months versus 16.4 months), but the difference varied strongly by sex. Female patients treated with DAC had a longer median OS (21.1 months, 95% CI: 16.0-28.0) than female patients treated with AZA (13.2 months, 95% CI: 11.0-15.9; p = .0014), while for males there was no significant difference between HMAs (median OS 18.3 months with DAC versus 17.9 months for AZA, p = .59). The biological reason for this variability is unclear, but may be a consequence of differences in cytidine deaminase activity between men and women.
高危骨髓增生异常综合征（MDS）的一线治疗包括地西他滨（DAC）或阿扎胞苷（AZA）。目前尚未发现变量能区分这两种药物的不同反应率。我们评估了642例接受AZA或DAC治疗的高危MDS患者中患者性别对包括总生存期（OS）在内的预后的影响。接受DAC治疗的患者（女性占35%，男性占31%）的OS略优于接受AZA治疗的患者（p = 0.043），（中位OS分别为18.7个月和16.4个月），但这种差异在不同性别中差异很大。接受DAC治疗的女性患者的中位OS更长（21.1个月，95%置信区间：16.0 - 28.0），而接受AZA治疗的女性患者为13.2个月（95%置信区间：11.0 - 15.9；p = 0.0014），而对于男性，两种造血干细胞移植药物之间没有显著差异（DAC治疗的中位OS为18.3个月，AZA治疗为17.9个月，p = 0.59）。这种变异性的生物学原因尚不清楚，但可能是男女之间胞苷脱氨酶活性差异的结果。
