Zhang S, Feng R, Li J T, Wang T, Zhang C L, Bai J F, Li Y, Shao R Y, Liu H
Department of Hematology, Beijing Hospital,National Center of Gerontology;Institute of Geriatric Medicine, Chinese Academy of Medical Science, Beijing 100730, China.
Zhonghua Nei Ke Za Zhi. 2021 Oct 1;60(10):880-885. doi: 10.3760/cma.j.cn112138-20201029-00904.
To evaluate the prognostic effects of two comprehensive geriatric assessment (CGA) methods in elderly patients with acute myeloid leukemia (AML). Ninety-seven patients with newly diagnosed AML at Beijing Hospital from August 2008 to December 2019 were included (≥60 years old). All patients were evaluated by two methods of CGA. One was IACA index proposed by Beijing Hospital, including instrumental activities of daily living (IADL), age, Charlson comorbidity index (CCI), albumin; the other was proposed by Italian FIL study group (FIL-CGA), including activities of daily living (ADL), IADL, age, and modified cumulative illness rating score for geriatrics (MCIRS-G). Among 97 patients, 54 patients received standard chemotherapy, 16 with decitabine, 2 with targeted therapy and 25 with the best supportive therapy. The overall response rate (ORR) in 72 treated patients were 67.7%, 33.3% and 0 respectively in fit, unfit and frail groups according to IACA index (=0.001). Based on FIL-CGA, the ORRs of fit, unfit and frail groups were 52.5%, 41.7% and 35.0% respectively (=0.418). The 1-year OS rates of fit, unfit and frail groups regarding IACA method were 78.7%, 27.7% and 0 respectively (<0.01). The 1-year OS rates of fit, unfit and frail groups regarding FIL-CGA method were 67.8%, 28.2% and 13.9% respectively (<0.01), while no significant difference was seen between unfit group and frail group (=0.111). The early death rates of fit, unfit and frail groups by IACA were 0, 6.0% and 28.6% respectively (=0.006), while those by FIL-CGA were 2.3%, 5.9%, 13.9% respectively (=0.123). Compared with FIL-CGA method, IACA predicts more effectively the treatment response, survival and early mortality in elderly patients with AML.
评估两种综合老年评估（CGA）方法对老年急性髓系白血病（AML）患者的预后影响。纳入2008年8月至2019年12月在北京医院新诊断的97例AML患者（年龄≥60岁）。所有患者均采用两种CGA方法进行评估。一种是北京医院提出的IACA指数，包括日常生活工具性活动（IADL）、年龄、Charlson合并症指数（CCI）、白蛋白；另一种是意大利FIL研究组提出的（FIL-CGA），包括日常生活活动（ADL）、IADL、年龄和老年改良累积疾病评分（MCIRS-G）。97例患者中，54例接受标准化疗，16例接受地西他滨治疗，2例接受靶向治疗，25例接受最佳支持治疗。根据IACA指数，72例接受治疗的患者中，适合、不适合和虚弱组的总缓解率（ORR）分别为67.7%、33.3%和0（=0.001）。基于FIL-CGA，适合、不适合和虚弱组的ORR分别为52.5%、41.7%和35.0%（=0.418）。IACA方法中适合、不适合和虚弱组的1年总生存率分别为78.7%、27.7%和0（<0.01）。FIL-CGA方法中适合、不适合和虚弱组的1年总生存率分别为67.8%、28.2%和13.9%（<0.01），而不适合组和虚弱组之间无显著差异（=0.111）。IACA方法中适合、不适合和虚弱组的早期死亡率分别为0、6.0%和28.6%（=0.006），而FIL-CGA方法中分别为2.3%、5.9%、13.9%（=0.123）。与FIL-CGA方法相比，IACA能更有效地预测老年AML患者的治疗反应、生存率和早期死亡率。
