低预处理老年营养风险指数与骨髓增生异常综合征患者阿扎胞苷不耐受的关系。

Relationship between Low Pretreatment Geriatric Nutritional Risk Index and Poor Tolerability of Azacitidine in Patients with Myelodysplastic Syndromes.

机构信息

Department of Pharmacy, NTT Medical Center Tokyo, Shinagawa, Tokyo, Japan.

Division of Pharmacy Professional Development and Research, Hoshi University School of Pharmacy and Pharmaceutical Sciences, Shinagawa, Tokyo, Japan.

出版信息

Ann Nutr Metab. 2020;76(6):405-412. doi: 10.1159/000513542. Epub 2021 Mar 4.

DOI:10.1159/000513542

PMID:33662960

Abstract

BACKGROUND

Predicting tolerability and treatment-related risks associated with azacitidine (AZA) in patients with myelodysplastic syndromes (MDS) before the initiation of therapy is required for appropriate treatment. Thus, in this study, the nutritional status of patients with MDS prior to AZA treatment was evaluated using the geriatric nutritional risk index (GNRI). Tolerability and overall survival (OS) after AZA initiation were also investigated.

METHODS

This was a single-center retrospective observational study. A total of 59 patients with MDS treated with AZA were assessed using GNRI, and a comparison of undernourished (GNRI <92, n = 27) and non-undernourished (GNRI ≥92, n = 32) patients was performed.

RESULTS

The undernourished group had a significant reduction in the number of patients that successfully completed 4 cycles of AZA treatment compared with the non-undernourished group (undernourished group, 11/27 patients, 40.7% vs. non-undernourished group, 24/32 patients, 75.0%; p = 0.009). Factors associated with the difference included karyotype and GNRI. There was also a significant increase in the rate of infectious complications in the undernourished group compared with the non-undernourished group (undernourished group, 33/60 cycles, 55.0% vs. non-undernourished group, 31/92 cycles, 33.7%; p = 0.012). Lastly, a significant reduction in OS was observed in the undernourished group compared with the non-undernourished group (undernourished group, 11.5 months; 95% CI, 5.2-16.7 vs. non-undernourished group, 21.9 months; 95% CI, 13.8-24.0; p = 0.026). Factors associated with OS included both the revised International Prognostic Scoring System (IPSS-R) and GNRI.

CONCLUSIONS

These results indicate that predicting treatment completion and adverse events in patients with MDS prior to AZA treatment is important. This study suggests GNRI may be a valuable nutritional assessment tool for determining tolerability and OS of AZA treatment.

摘要

背景

在开始治疗之前，预测骨髓增生异常综合征（MDS）患者使用阿扎胞苷（AZA）的耐受性和与治疗相关的风险对于适当的治疗至关重要。因此，在这项研究中，使用老年营养风险指数（GNRI）评估了 AZA 治疗前 MDS 患者的营养状况。还研究了 AZA 治疗开始后的耐受性和总生存期（OS）。

方法

这是一项单中心回顾性观察性研究。共评估了 59 例接受 AZA 治疗的 MDS 患者的 GNRI，比较了营养不足（GNRI<92，n=27）和非营养不足（GNRI≥92，n=32）患者。

结果

与非营养不足组相比，营养不足组成功完成 4 个 AZA 治疗周期的患者数量明显减少（营养不足组 11/27 例，40.7% vs. 非营养不足组 24/32 例，75.0%；p=0.009）。与差异相关的因素包括核型和 GNRI。营养不足组的感染并发症发生率也明显高于非营养不足组（营养不足组 60 个周期 33/60 例，55.0% vs. 非营养不足组 92 个周期 31/92 例，33.7%；p=0.012）。最后，与非营养不足组相比，营养不足组的 OS 明显降低（营养不足组 11.5 个月；95%CI，5.2-16.7 vs. 非营养不足组 21.9 个月；95%CI，13.8-24.0；p=0.026）。与 OS 相关的因素包括修订后的国际预后评分系统（IPSS-R）和 GNRI。