Breccia Massimo, Palandri Francesca, Luciano Luigiana, Benevolo Giulia, Bonifacio Massimiliano, Caocci Giovanni, Castagnetti Fausto, Palumbo Giuseppe A, Iurlo Alessandra, Landi Francesco
Università Sapienza, Azienda Ospedaliera Policlinico Umberto I, Via Benevento 6, 00161, Rome, Italy.
Azienda Ospedaliera Policlinico S. Orsola-Malpighi, Università di Bologna, Bologna, Italy.
Ann Hematol. 2018 May;97(5):745-754. doi: 10.1007/s00277-018-3258-0. Epub 2018 Feb 22.
The incidence of cancer, including myeloproliferative neoplasms (MPNs), is projected to increase significantly due to the growing proportion of people aged > 65 years. These older individuals are a heterogeneous population in terms of fitness, comorbidity, and psychological reserve. Therefore, age per se does not always provide an accurate indication of condition in patients with cancer. Frailty has been proposed as an alternative measure of vulnerability that might better indicate which patients can tolerate standard cancer treatment and those who may benefit from treatment adjustment. A number of methods can be used to assess frailty in older patients with hematological malignancies, including the Cardiovascular Health Study Frailty Screening Measure, the FRAIL (Fatigue, Resistance, Ambulation, Illnesses, and Loss of weight) questionnaire, the Clinical Frailty Scale (CFS), and the Gérontopôle Frailty Screening Tool. In addition to physical frailty, comorbidity and quality of life should also be included in the assessment. Prior to the introduction of tyrosine kinase inhibitors (TKIs), age was considered a marker of poor prognosis in patients with MPNs. In contrast, data show that age is not necessarily a contraindication for TKI use. In CML, the efficacy of TKIs has been shown to be independent of age. The JAK1/2 inhibitor ruxolitinib also seems to be effective across a range of patient ages. Available data suggest that chronological age itself should not necessarily be a contraindication for many new therapies in patients with MPNs, and that frailty does provide a better measure of vulnerability. There is a need for specific methods to assess frailty in patients with MPNs, particularly the context of effective new treatment options, such as TKIs and ruxolitinib.
由于65岁以上人群比例不断增加，包括骨髓增殖性肿瘤（MPN）在内的癌症发病率预计将显著上升。这些老年人在身体状况、合并症和心理储备方面是一个异质性群体。因此，年龄本身并不总是能准确反映癌症患者的病情。衰弱已被提议作为一种衡量脆弱性的替代指标，它可能更好地表明哪些患者能够耐受标准癌症治疗，以及哪些患者可能受益于治疗调整。有多种方法可用于评估老年血液系统恶性肿瘤患者的衰弱程度，包括心血管健康研究衰弱筛查量表、FRAIL（疲劳、抵抗力、活动能力、疾病和体重减轻）问卷、临床衰弱量表（CFS）和老年医学中心衰弱筛查工具。除了身体衰弱外，合并症和生活质量也应纳入评估。在酪氨酸激酶抑制剂（TKI）问世之前，年龄被认为是MPN患者预后不良的一个标志。相比之下，数据表明年龄不一定是使用TKI的禁忌症。在慢性粒细胞白血病（CML）中，TKI的疗效已被证明与年龄无关。JAK1/2抑制剂鲁索替尼在一系列患者年龄范围内似乎也有效。现有数据表明，实际年龄本身不一定是MPN患者许多新疗法的禁忌症，而且衰弱确实能更好地衡量脆弱性。需要有特定的方法来评估MPN患者的衰弱程度，特别是在有有效的新治疗选择（如TKI和鲁索替尼）的情况下。
