Fondazione Ricerca e Salute, Roma, Italy.
Drugs & Health Srl, Roma, Italy.
Tumori. 2023 Oct;109(5):496-503. doi: 10.1177/03008916231153698. Epub 2023 Mar 9.
To identify newly diagnosed patients with acute myeloid leukemia in 2017 treated with intensive chemotherapy or unfit for intensive chemotherapy, and to assess their probability of receiving allogeneic stem cell transplantation and survival, from the Italian National Health Service perspective.
From the Ricerca e Salute database, adults with an in-hospital diagnosis of acute myeloid leukemia (International Classification of Disease-9th version-Clinical Modification code 205.0x) in 2017 (index date), without any identifying acute myeloid leukemia criteria within the preceding year, were selected. Among them, subjects treated with intensive chemotherapy (chemotherapy during an overnight hospitalization) within one year after index date were identified. The remaining were considered unfit for intensive chemotherapy. Gender, age and comorbidities were described. Within the follow-up period, probabilities of in-hospital allogeneic stem cell transplantation and overall survival were assessed through Kaplan Meier analyses.
From 4,840,063 beneficiaries of the Italian National Health Service, 368 newly acute myeloid leukemia diagnosed adults (9.0 *100,000) were selected. Males comprised 57%. Mean age was 68±15. There were 197 patients treated with intensive chemotherapy. The remaining 171 unfit for intensive chemotherapy were older (72±14) and with more comorbidities (e.g. hypertension, chronic lung diseases and chronic kidney disease). Only patients treated with intensive chemotherapy underwent an allogeneic stem cell transplantation (41; 33%) during the one year after the index date. Within the first and second follow-up year, respectively: 41.1% and 26.9% of subjects treated with intensive chemotherapy (144) survived (median survival time: 7.8 months); 25.7% and 18.7% of those unfit for intensive chemotherapy (139) survived (1.2 months). Difference was significant (p<0.0001). Within one and two years after transplantation (41 patients), 73.5% and 67.3% of subjects survived, respectively.
This study, by showing the incidence of acute myeloid leukemia in Italy in 2017, the proportion of patients treated with intensive chemotherapy from the new diagnosis, the use of allogeneic stem cell transplantation and two-year survival, integrated evidence on large and unselected populations and may help to improve treatment strategies of older acute myeloid leukemia patients.
从意大利国家卫生服务的角度，确定 2017 年接受强化化疗或不适合强化化疗的新诊断急性髓系白血病患者，并评估他们接受异基因干细胞移植和生存的概率。
从 Ricerca e Salute 数据库中，选择 2017 年（索引日期）在住院期间诊断为急性髓系白血病（国际疾病分类第 9 版临床修正版代码 205.0x）的成年人，在过去 1 年内没有任何急性髓系白血病标准。其中，在索引日期后一年内接受强化化疗（住院过夜期间化疗）的患者被识别。其余的被认为不适合强化化疗。描述了性别、年龄和合并症。在随访期间，通过 Kaplan-Meier 分析评估住院异体干细胞移植和总体生存率的概率。
从意大利国家卫生服务的 4840063 名受益人中，选择了 368 名新诊断的急性髓系白血病成年患者（9.0*100000）。男性占 57%。平均年龄为 68±15 岁。有 197 名患者接受强化化疗。其余 171 名不适合强化化疗的患者年龄较大（72±14 岁），合并症较多（如高血压、慢性肺部疾病和慢性肾脏病）。只有接受强化化疗的患者在索引日期后一年进行了异基因干细胞移植（41 例；33%）。在第一个和第二个随访年内，分别有：接受强化化疗的 144 名患者（41.1%和 26.9%）存活（中位生存时间：7.8 个月）；139 名不适合强化化疗的患者（25.7%和 18.7%）存活（1.2 个月）。差异有统计学意义（p<0.0001）。在移植后 1 年和 2 年内（41 例），分别有 73.5%和 67.3%的患者存活。
本研究通过展示 2017 年意大利急性髓系白血病的发病率、新诊断患者接受强化化疗的比例、异基因干细胞移植的应用和两年生存率，为大型、未选择的人群提供了综合证据，可能有助于改善老年急性髓系白血病患者的治疗策略。
