Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, 560029, India.
Ann Hematol. 2019 Apr;98(4):881-888. doi: 10.1007/s00277-019-03600-6. Epub 2019 Jan 29.
Elderly patients with acute myeloid leukemia have a poor prognosis. Data from developing countries is sparse in the literature. In this retrospective study, 402 patients aged ≥ 60 years, diagnosed between Jan 2013 and Dec 2017, were analyzed for treatment patterns and survival. Median age of the whole cohort was 68 years (range 61-84). A total of 213 patients (53.3%) refused care; 188 patients (46.7%) received either BSC, LDAC, or HMA. Survival (in months) was 3.9, 6.4, and 1.2 with LDAC, HMA, and BSC, respectively. One-year survival was 17.2% and 6% with HMA and LDAC, respectively (P = 0.02). Overall response rate (ORR) did not differ between HMA and LDAC group (p = 0.12). HMA cohort had higher complete responses (20.6% vs 7.4%, p = 0.02), stable disease (32.7% vs 13.5%, p = 0.02), and transfusion independence (TI) (46.5% vs 22.2%, p = 0.01). Survival did not differ between the groups if the patients achieved ORR (12.3 vs 9.8 p = 0.2) or TI (11.6 vs 6.4 p = 0.2). Stable disease with HMA led to longer survival (8.1 vs 5.3 p = 0.01). HMAs were more effective than LDAC irrespective of cytogenetic risk category and blasts, of note HMAs improved survival of poor risk patients (5.6 vs 2.9 p = 0.004). HMA treatment (HR = 0.48; 95% 0.29-0.79, p = 0.004) and transfusion independence (HR = 0.2; 95% 0.1-0.3, p = 0.0001) predicted survival in multivariate analysis. Neutropenia and febrile neutropenia were frequent in HMA. Thrombocytopenia was the common adverse event with LDAC. Novel and cost-effective drugs are essential to improve the prognosis of these patients.
老年急性髓系白血病患者预后较差。发展中国家的数据在文献中较为匮乏。在这项回顾性研究中，分析了 2013 年 1 月至 2017 年 12 月期间诊断为年龄≥60 岁的 402 例患者的治疗模式和生存情况。全队列的中位年龄为 68 岁（范围 61-84）。共有 213 例患者（53.3%）拒绝治疗；188 例患者（46.7%）接受了 BSC、LDAC 或 HMA 治疗。LDAC、HMA 和 BSC 治疗的生存（月）分别为 3.9、6.4 和 1.2。HMA 和 LDAC 组的 1 年生存率分别为 17.2%和 6%（P=0.02）。HMA 和 LDAC 组的总体缓解率（ORR）无差异（p=0.12）。HMA 组完全缓解率（20.6%比 7.4%，p=0.02）、稳定疾病率（32.7%比 13.5%，p=0.02）和输血独立性（TI）率（46.5%比 22.2%，p=0.01）更高。如果患者达到 ORR（12.3%比 9.8%，p=0.2）或 TI（11.6%比 6.4%，p=0.2），两组的生存情况无差异。HMA 诱导的稳定疾病可延长生存（8.1 比 5.3，p=0.01）。HMAs 比 LDAC 更有效，无论细胞遗传学风险类别和原始细胞百分比如何，值得注意的是，HMAs 改善了高危患者的生存（5.6 比 2.9，p=0.004）。多因素分析显示，HMA 治疗（HR=0.48；95%CI 0.29-0.79，p=0.004）和输血独立性（HR=0.2；95%CI 0.1-0.3，p=0.0001）可预测生存。HMA 组常出现中性粒细胞减少和发热性中性粒细胞减少。血小板减少是 LDAC 的常见不良事件。新型、具有成本效益的药物对于改善这些患者的预后至关重要。
