20 余年来老年急性髓系白血病患者的临床结局：大型三级转诊中心的分析。

Clinical outcome of older adults with acute myeloid Leukemia: An analysis of a large tertiary referral Center over two decades.

机构信息

Department of Hematology, Oncology and Tumor Immunology, Charité - Universitätsmedizin Berlin, Campus Virchow-Clinic, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany; Institute of Pathology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.

出版信息

J Geriatr Oncol. 2021 May;12(4):540-549. doi: 10.1016/j.jgo.2020.11.001. Epub 2020 Nov 19.

DOI:10.1016/j.jgo.2020.11.001

PMID:33223482

Abstract

OBJECTIVE

In older adults with acute myeloid leukemia (AML), the overall outcome is still dismal and long-term data on survival are scarce, particularly outside of clinical trials. Here, we assess characteristics, prognostic factors and long-term survival in patients ≥60 years who were treated for AML at our center over the past 17 years.

METHODS

590 older adults with newly diagnosed AML were characterized according to Eastern Cooperative Oncology Group (ECOG) score, Charlson comorbidity index (CCI), European LeukemiaNet (ELN) risk, type of therapy, serum ferritin (SF) and further baseline characteristics. Survival analysis was performed accordingly.

RESULTS

Median age was 68 years and most patients were in good general condition. Median follow-up was 55.8 months. Of all patients, 66% received intensive chemotherapy (IC) +/- allogeneic hematopoietic stem cell transplantation (allo-HSCT). The remaining cohort received palliative chemotherapy (PC, 26%) or best supportive care only (BSC, 8%). Enrollment rate for interventional clinical trials was 26%. 5-year overall survival (OS) and relapse-free survival (RFS) were 18% (median 12.5 months) and 11,5% (median 10.0 months). Long-term survival was independently influenced by ECOG score, ELN risk group, baseline SF, previous myocardial infarction, and choice of therapy, but not consistently by age or CCI. Considering therapeutic subgroups, the contribution of particular parameters in predicting OS was most compelling in IC patients, but less consistent with PC or BSC.

CONCLUSION

Our results provide thorough insights into prognostication within therapeutic subgroups and emphasize the need for more detailed prognostic algorithms and routine geriatric assessment in the treatment of older adults with AML.

摘要

目的

在老年急性髓系白血病（AML）患者中，整体预后仍然较差，且生存的长期数据稀缺，尤其是在临床试验之外。在此，我们评估了过去 17 年来在我们中心接受 AML 治疗的年龄≥60 岁患者的特征、预后因素和长期生存情况。

方法

根据东部肿瘤协作组（ECOG）评分、Charlson 合并症指数（CCI）、欧洲白血病网络（ELN）风险、治疗类型、血清铁蛋白（SF）和其他基线特征，对 590 例新诊断为 AML 的老年患者进行特征描述。相应地进行生存分析。

结果

中位年龄为 68 岁，大多数患者一般状况良好。中位随访时间为 55.8 个月。所有患者中，66%接受强化化疗（IC）±异基因造血干细胞移植（allo-HSCT）。其余患者接受姑息化疗（PC，26%）或仅接受最佳支持治疗（BSC，8%）。干预性临床试验的入组率为 26%。5 年总生存（OS）和无复发生存（RFS）分别为 18%（中位 12.5 个月）和 11.5%（中位 10.0 个月）。长期生存独立受 ECOG 评分、ELN 风险组、基线 SF、既往心肌梗死和治疗选择的影响，但与年龄或 CCI 不一致。考虑到治疗亚组，在 IC 患者中，特定参数在预测 OS 方面的贡献最为明显，但在 PC 或 BSC 患者中则不太一致。