肾功能对老年急性髓系白血病患者生存的影响。

The impact of kidney function on survival in elderly patients diagnosed with acute myeloid leukemia.

出版信息

Clin Nephrol. 2021;96(1):31-35. doi: 10.5414/CNP96S06.

Abstract

BACKGROUND

Acute myeloid leukemia (AML) is an aggressive hematological cancer that involves myeloid cells. Elderly patients with comorbidities and poor performance status (PS) receive treatment with hypomethylating agents or supportive care. Several models are available to predict treatment-related mortality and they all primarily focus on PS. Little is known about the impact of chronic kidney disease (CKD) on survival in elderly patients with AML.

MATERIALS AND METHODS

We performed a retrospective analysis of 81 patients (51.9% male) aged over 65 years when the diagnosis of AML was established. The median observation period lasted 108 days (IQR 292, maximum 1,169). Patients' documentation was examined for previous illnesses, PS was calculated, basic laboratory blood tests and a bone marrow biopsy were done. CKD was defined as an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73m.

RESULTS

The median age of patients was 75 years (IQR 14, maximum 93). The mean eGFR was 59.5 ± 24.0 mL/min/1.73m. CKD was present in almost half of patients (49.4%). Altogether, 69 (85.2%) patients died during the observation period. Kaplan-Meier survival analysis showed statistically lower survival for CKD patients (log-rank χ2 = 6.736; p = 0.009). Cox regression model, adjusted for age, comorbidities, and treatment, revealed the main predictors for patient survival to be PS, AML type, and blast percentage.

CONCLUSION

Our results indicate that elderly patients with AML have worse survival when diagnosed with CKD, however CKD was not one of the main predictors of patient survival.

摘要

背景

急性髓系白血病（AML）是一种侵袭性血液系统恶性肿瘤，涉及髓系细胞。患有合并症和较差表现状态（PS）的老年患者接受低甲基化剂治疗或支持性护理。有几种模型可用于预测与治疗相关的死亡率，这些模型主要都集中在 PS 上。关于慢性肾脏病（CKD）对老年 AML 患者生存的影响知之甚少。

材料和方法

我们对 81 名年龄超过 65 岁的 AML 患者（51.9%为男性）进行了回顾性分析。中位观察期持续 108 天（IQR 292，最长 1169）。检查患者的既往病史记录、计算 PS、进行基本实验室血液检查和骨髓活检。CKD 定义为估算肾小球滤过率（eGFR）<60 mL/min/1.73m。

结果

患者的中位年龄为 75 岁（IQR 14，最大 93）。平均 eGFR 为 59.5±24.0 mL/min/1.73m。近一半的患者（49.4%）存在 CKD。在观察期间，共有 69 名（85.2%）患者死亡。Kaplan-Meier 生存分析显示 CKD 患者的生存率明显较低（对数秩 χ2=6.736；p=0.009）。调整年龄、合并症和治疗后，Cox 回归模型显示 PS、AML 类型和原始细胞百分比是患者生存的主要预测因素。