Lee Je-Hwan, Kim Yoo-Jin, Sohn Sang Kyun, Yoon Sung-Soo, Kim Hawk, Cheong June-Won, Lee Won-Sik, Lee Gyeong-Won, Lim Sung-Nam, Kim Min Kyoung, Lee Ho Sup, Kim Hyeoung-Joon
Department of Hematology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Department of Hematology, Cancer Research Institute, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Leuk Res. 2017 Sep;60:135-144. doi: 10.1016/j.leukres.2017.08.004. Epub 2017 Aug 15.
We retrospectively analyzed the results of hypomethylating therapy in 586 patients (azacitidine in 423 and decitabine in 163) with International Prognostic Scoring System (IPSS) lower-risk myelodysplastic syndrome (MDS). The patients were reclassified with newer scoring systems (revised IPSS [R-IPSS], revised WHO classification-based Prognostic Scoring System [R-WPSS], and Lower Risk Prognostic Scoring System [LR-PSS]), and 21.8-38.4% of patients had high or very high risk features by the newer scoring systems. Median overall survival (OS) was 27.3 months and newer scoring systems well stratified the patients in terms of OS (R-IPSS, P=0.001; R-WPSS, P<0.001; LR-PSS, P<0.001). Hematologic improvement (HI) was observed in 279 patients (47.6%). OS differed by the achievement of HI (39.4% vs. 36.2%, P=0.067). The differences were significant only in patients of intermediate or high risk group by LR-PSS (P=0.034) or R-IPSS (P=0.018). In summary, IPSS lower-risk MDS included a broad range of prognosis, and hypomethylating therapy induced HI in approximately half of the patients. Achievement of HI was associated with longer survival, especially in patients with intermediate or high risk features by newer scoring systems. Hypomethylating therapy seems to have potential benefits in IPSS lower-risk MDS.
我们回顾性分析了586例国际预后评分系统（IPSS）低危骨髓增生异常综合征（MDS）患者（423例使用阿扎胞苷，163例使用地西他滨）接受去甲基化治疗的结果。使用更新的评分系统（修订的IPSS [R-IPSS]、基于世界卫生组织修订分类的预后评分系统[R-WPSS]和低危预后评分系统[LR-PSS]）对患者进行重新分类，21.8%-38.4%的患者根据更新的评分系统具有高危或极高危特征。中位总生存期（OS）为27.3个月，更新的评分系统在OS方面对患者进行了良好的分层（R-IPSS，P=0.001；R-WPSS，P<0.001；LR-PSS，P<0.001）。279例患者（47.6%）观察到血液学改善（HI）。OS因HI的实现而有所不同（39.4%对36.2%，P=0.067）。仅在LR-PSS（P=0.034）或R-IPSS（P=0.018）的中危或高危组患者中差异显著。总之，IPSS低危MDS包括广泛的预后范围，去甲基化治疗在大约一半的患者中诱导了HI。HI的实现与更长的生存期相关，尤其是在根据更新的评分系统具有中危或高危特征的患者中。去甲基化治疗似乎在IPSS低危MDS中具有潜在益处。
