Choi Eun-Ji, Lee Je-Hwan, Park Han-Seung, Lee Jung-Hee, Seol Miee, Lee Young-Shin, Kang Young-Ah, Jeon Mijin, Woo Ji Min, Lee Kyoo-Hyung
Department of Hematology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Department of Hematology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Clin Lymphoma Myeloma Leuk. 2019 May;19(5):290-299.e3. doi: 10.1016/j.clml.2019.02.002. Epub 2019 Feb 20.
Elderly patients with acute myeloid leukemia (AML) have generally had a poor prognosis with unfavorable clinical and biologic disease features. Hypomethylating agents have shown potential for treating medically unfit and elderly patients with AML.
We compared the outcomes of elderly patients with AML treated with decitabine and intensive chemotherapy (IC).
The data from 107 patients with newly diagnosed AML aged ≥ 65 years were analyzed. The overall response rate was 38.6% and was significantly greater in the IC group than in the decitabine group (65.6% vs. 26.1%; P < .001). With a median follow-up duration of survivors of 14.8 months, the median overall survival (OS) and event-free survival were 12.3 months (95% confidence interval [CI], 10.0-14.7) and 2.0 months (95% CI, 2.0-2.0), respectively, which were not different between the 2 treatment groups. The FLT3-internal tandem duplication mutation (hazard ratio [HR], 2.637; 95% CI, 1.379-5.043; P = .003), complex karyotype (HR, 2.513; 95% CI, 1.258-5.020; P = .009), and peripheral blood blast percentage at diagnosis (HR, 1.983; 95% CI, 1.148-3.422; P = .014) were analyzed as independent prognostic factors for OS. A subgroup analysis for OS showed that IC was superior to decitabine for patients with the FLT3-internal tandem duplication mutation (P = .025) and poor risk cytogenetics, except for -7/del(7q) (P = .005), and decitabine was associated with longer OS for patients with -7/del(7q) (P = .077).
Decitabine showed a similar OS to IC, despite the lower response rate in patients. The clinical outcomes of specific subgroups seemed to differ with different treatment options. Optimal therapeutic approaches for elderly patients with AML should be further examined.
老年急性髓系白血病（AML）患者通常预后较差，具有不良的临床和生物学疾病特征。去甲基化药物已显示出治疗身体状况不佳的老年AML患者的潜力。
我们比较了接受地西他滨和强化化疗（IC）治疗的老年AML患者的结局。
分析了107例年龄≥65岁的新诊断AML患者的数据。总缓解率为38.6%，IC组显著高于地西他滨组（65.6%对26.1%；P <.001）。存活者的中位随访时间为14.8个月，中位总生存期（OS）和无事件生存期分别为12.3个月（95%置信区间[CI]，10.0 - 14.7）和2.0个月（95%CI，2.0 - 2.0），两组治疗组之间无差异。FLT3内部串联重复突变（风险比[HR]，2.637；95%CI，1.379 - 5.043；P =.003）、复杂核型（HR，2.513；95%CI，1.258 - 5.020；P =.009）和诊断时外周血原始细胞百分比（HR，1.983；95%CI，1.148 - 3.422；P =.014）被分析为OS的独立预后因素。OS的亚组分析显示，对于FLT3内部串联重复突变患者（P =.025）和除-7/del(7q)外的不良风险细胞遗传学患者（P =.005），IC优于地西他滨，而对于-7/del(7q)患者，地西他滨与更长的OS相关（P =.077）。
尽管患者缓解率较低，但地西他滨显示出与IC相似的OS。特定亚组的临床结局似乎因不同的治疗选择而异。应进一步研究老年AML患者的最佳治疗方法。
