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年龄 70 岁或以上、适合强化化疗的 AML 患者的评分系统:一项基于 DATAML、SAL 和 PETHEMA 登记处的大型欧洲数据集的研究。

A scoring system for AML patients aged 70 years or older, eligible for intensive chemotherapy: a study based on a large European data set using the DATAML, SAL, and PETHEMA registries.

机构信息

Centre Hospitalier Universitaire de Toulouse, Service d'Epidémiologie, CERPOP, Inserm, Université Toulouse III Paul Sabatier, Toulouse, France.

Medizinische Klinik und Poliklinik I, Universitätsklinikum TU Dresden, Dresden, Germany.

出版信息

Blood Cancer J. 2022 Jul 11;12(7):107. doi: 10.1038/s41408-022-00700-x.


DOI:10.1038/s41408-022-00700-x
PMID:35821023
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9276717/
Abstract

In a context of therapeutic revolution in older adults with AML, it is becoming increasingly important to select patients for the various treatment options by taking account of short-term efficacy and toxicity as well as long-term survival. Here, the data from three European registries for 1,199 AML patients aged 70 years or older treated with intensive chemotherapy were used to develop a prognostic scoring system. The median follow-up was 50.8 months. In the training set of 636 patients, age, performance status, secondary AML, leukocytosis, and cytogenetics, as well as NPM1 mutations (without FLT3-ITD), were all significantly associated with overall survival, albeit not to the same degree. These factors were used to develop a score that predicts long-term overall survival. Three risk-groups were identified: a lower, intermediate and higher-risk score with predicted 5-year overall survival (OS) probabilities of ≥12% (n = 283, 51%; median OS = 18 months), 3-12% (n = 226, 41%; median OS = 9 months) and <3% (n = 47, 8%; median OS = 3 months), respectively. This scoring system was also significantly associated with complete remission, early death and relapse-free survival; performed similarly in the external validation cohort (n = 563) and showed a lower false-positive rate than previously published scores. The European Scoring System ≥70, easy for routine calculation, predicts long-term survival in older AML patients considered for intensive chemotherapy.

摘要

在老年 AML 患者的治疗革命背景下,通过考虑短期疗效和毒性以及长期生存来为各种治疗选择选择患者变得越来越重要。在这里,使用来自三个欧洲 AML 登记处的 1199 名 70 岁或以上接受强化化疗的 AML 患者的数据来开发预后评分系统。中位随访时间为 50.8 个月。在 636 名患者的训练集中,年龄、表现状态、继发性 AML、白细胞增多和细胞遗传学,以及 NPM1 突变(无 FLT3-ITD),均与总生存显著相关,尽管程度不同。这些因素被用来开发一种能够预测长期总生存的评分。确定了三个风险组:低、中、高风险评分,预测 5 年总生存率(OS)概率分别为≥12%(n=283,51%;中位 OS=18 个月)、3-12%(n=226,41%;中位 OS=9 个月)和<3%(n=47,8%;中位 OS=3 个月)。该评分系统与完全缓解、早期死亡和无复发生存率也显著相关;在外部验证队列(n=563)中表现相似,并显示出比以前发表的评分更低的假阳性率。欧洲评分系统≥70,易于常规计算,可预测考虑强化化疗的老年 AML 患者的长期生存。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5319/9276717/9101a8fc9f0f/41408_2022_700_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5319/9276717/0e8e4e256f86/41408_2022_700_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5319/9276717/b695f17e5dd0/41408_2022_700_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5319/9276717/9101a8fc9f0f/41408_2022_700_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5319/9276717/0e8e4e256f86/41408_2022_700_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5319/9276717/b695f17e5dd0/41408_2022_700_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5319/9276717/9101a8fc9f0f/41408_2022_700_Fig3_HTML.jpg

相似文献

[1]
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引用本文的文献

[1]
Diverse real-life outcomes after intensive risk-adapted therapy for 1034 AML patients from the CETLAM Group.

Blood Cancer J. 2025-1-11

[2]
Determining treatment tolerance and fitness for intensive chemotherapy in older adults with AML: a call to action.

Blood. 2024-2-8

[3]
Optimizing Treatment Options for Newly Diagnosed Acute Myeloid Leukemia in Older Patients with Comorbidities.

Cancers (Basel). 2023-4-21

本文引用的文献

[1]
Can venetoclax-based therapy replace 7+3 induction in fit older adults with AML?

Best Pract Res Clin Haematol. 2021-12

[2]
Long-term survival after intensive chemotherapy or hypomethylating agents in AML patients aged 70 years and older: a large patient data set study from European registries.

Leukemia. 2022-4

[3]
Venetoclax and azacitidine compared with induction chemotherapy for newly diagnosed patients with acute myeloid leukemia.

Blood Adv. 2021-12-28

[4]
Acute myeloid leukemia after age 70 years: A retrospective comparison of survival following treatment with intensive versus HMA ± venetoclax chemotherapy.

Am J Hematol. 2021-4-1

[5]
Oral Azacitidine Maintenance Therapy for Acute Myeloid Leukemia in First Remission.

N Engl J Med. 2020-12-24

[6]
Azacitidine and Venetoclax in Previously Untreated Acute Myeloid Leukemia.

N Engl J Med. 2020-8-13

[7]
The Changing Landscape of Treatment in Acute Myeloid Leukemia.

Am Soc Clin Oncol Educ Book. 2020-3

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Venetoclax plus LDAC for newly diagnosed AML ineligible for intensive chemotherapy: a phase 3 randomized placebo-controlled trial.

Blood. 2020-6-11

[9]
PROBAST: A Tool to Assess Risk of Bias and Applicability of Prediction Model Studies: Explanation and Elaboration.

Ann Intern Med. 2019-1-1

[10]
CPX-351 (cytarabine and daunorubicin) Liposome for Injection Versus Conventional Cytarabine Plus Daunorubicin in Older Patients With Newly Diagnosed Secondary Acute Myeloid Leukemia.

J Clin Oncol. 2018-7-19

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