慢性髓性白血病患者总生存的预后因素：意大利慢性髓性白血病GIMEMA网络的一项多中心队列研究
Prognostic Factors for Overall Survival In Chronic Myeloid Leukemia Patients: A Multicentric Cohort Study by the Italian CML GIMEMA Network.
作者信息
Specchia Giorgina, Pregno Patrizia, Breccia Massimo, Castagnetti Fausto, Monagheddu Chiara, Bonifacio Massimiliano, Tiribelli Mario, Stagno Fabio, Caocci Giovanni, Martino Bruno, Luciano Luigiana, Pizzuti Michele, Gozzini Antonella, Scortechini Anna Rita, Albano Francesco, Bergamaschi Micaela, Capodanno Isabella, Patriarca Andrea, Fava Carmen, Rege-Cambrin Giovanna, Sorà Federica, Galimberti Sara, Bocchia Monica, Binotto Gianni, Reddiconto Giovanni, DiTonno Paolo, Maggi Alessandro, Sanpaolo Grazia, De Candia Maria Stella, Giai Valentina, Abruzzese Elisabetta, Miggiano Maria Cristina, La Barba Gaetano, Pietrantuono Giuseppe, Guella Anna, Levato Luciano, Mulas Olga, Saccona Fabio, Rosti Gianantonio, Musto Pellegrino, Di Raimondo Francesco, Pane Fabrizio, Baccarani Michele, Saglio Giuseppe, Ciccone Giovannino
机构信息
Former Full Professor of Hematology- University of Bari Aldo Moro" Bari GIMEMA WP CML, Bari, Italy.
Haematology Unit, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza, Torino, Italy.
出版信息
Front Oncol. 2021 Aug 26;11:739171. doi: 10.3389/fonc.2021.739171. eCollection 2021.
An observational prospective study was conducted by the CML Italian network to analyze the role of baseline patient characteristics and first line treatments on overall survival and CML-related mortality in 1206 newly diagnosed CML patients, 608 treated with imatinib (IMA) and 598 with 2 generation tyrosine kinase inhibitors (2GTKI). IMA-treated patients were much older (median age 69 years, IQR 58-77) than the 2GTKI group (52, IQR 41-63) and had more comorbidities. Estimated 4-year overall survival of the entire cohort was 89% (95%CI 85.9-91.4). Overall, 73 patients (6.1%) died: 17 (2.8%) in the 2GTKI vs 56 (9.2%) in the IMA cohort (adjusted HR=0.50; 95% CI=0.26-0.94), but no differences were detected for CML-related mortality (10 (1.7%) vs 11 (1.8%) in the 2GTKIs vs IMA cohort (sHR=1.61; 0.52-4.96). The ELTS score was associated to CML mortality (high risk vs low, HR=9.67; 95%CI 2.94-31.74; p<0.001), while age (per year, HR=1.03; 95%CI 1.00-1.06; p=0.064), CCI (4-5 vs 2, HR=5.22; 95%CI 2.56-10.65; p<0.001), ELTS score (high risk vs low, HR=3.11; 95%CI 1.52-6.35, p=0.002) and 2GTKI vs IMA (HR=0.26; 95%CI 0.10-0.65, p=0.004) were associated to an increased risk of non-related CML mortality. The ELTS score showed a better discriminant ability than the Sokal score in all comparisons.
意大利慢性粒细胞白血病（CML）网络开展了一项前瞻性观察性研究，以分析1206例新诊断CML患者的基线患者特征和一线治疗对总生存期及CML相关死亡率的影响，其中608例接受伊马替尼（IMA）治疗，598例接受第二代酪氨酸激酶抑制剂（2GTKI）治疗。接受IMA治疗的患者比2GTKI组患者年龄大得多（中位年龄69岁，四分位间距58 - 77），且合并症更多。整个队列的4年总生存率估计为89%（95%置信区间85.9 - 91.4）。总体而言，73例患者（6.1%）死亡：2GTKI组17例（2.8%），IMA队列中56例（9.2%）（校正风险比=0.50；95%置信区间=0.26 - 0.94），但CML相关死亡率未检测到差异（2GTKI组10例（1.7%），IMA队列中11例（1.8%）（标准化风险比=1.61；0.52 - 4.96）。ELTS评分与CML死亡率相关（高风险与低风险相比，风险比=9.67；95%置信区间2.94 - 31.74；p<0.001），而年龄（每年，风险比=1.03；95%置信区间1.00 - 1.06；p=0.064）、Charlson合并症指数（4 - 5与2相比，风险比=5.22；95%置信区间2.56 - 10.65；p<0.001）、ELTS评分（高风险与低风险相比，风险比=3.11；95%置信区间1.52 - 6.35，p=0.002）以及2GTKI与IMA（风险比=0.26；95%置信区间0.10 - 0.65，p=0.004）与非CML相关死亡率增加风险相关。在所有比较中，ELTS评分显示出比Sokal评分更好的判别能力。
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