IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori "Dino Amadori" (IRST), Meldola, Italy.
Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy.
Cancer Med. 2023 May;12(10):11838-11848. doi: 10.1002/cam4.5858. Epub 2023 Mar 31.
In older patients with acute myeloid leukemia (AML), the definition of fitness, prognosis, and risk of death represents an open question.
In the present study, we tested the impact on survival of disease- and patient-related parameters in a large cohort of elderly AML patients homogeneously assigned to treatment with hypomethylating agents (HMAs).
In 131 patients with a median age of 76 years, we confirmed that early response (<0.001) and biology-based risk classification (p = 0.003) can select patients with better-predicted survival. However, a full disease-oriented model had limitations in stratifying our patients, prompting us to investigate the impact of baseline comorbidities on overall survival basing on a comorbidity score. The albumin level (p = 0.001) and the presence of lung disease (p = 0.013) had a single-variable impact on prognosis. The baseline comorbidity burden was a powerful predictor of patients' frailty, correlating with increased incidence of adverse events, especially infections, and predicted overall survival (p < 0.001).
The comorbidity burden may contribute to impact prognosis in addition to disease biology. While the therapeutic armamentarium of elderly AML is improving, a comprehensive approach that combines AML biology with tailored interventions to patients' frailty is likely to fully exploit the anti-leukemia potential of novel drugs.
在老年急性髓系白血病（AML）患者中，体能、预后和死亡风险的定义仍是一个悬而未决的问题。
本研究中，我们在接受低甲基化剂（HMAs）治疗的老年 AML 患者大队列中，检测了疾病和患者相关参数对生存的影响，这些患者均经过同质分组。
在 131 例中位年龄为 76 岁的患者中，我们证实早期反应（<0.001）和基于生物学的风险分类（p=0.003）可选择具有更好预测生存的患者。然而，完全基于疾病的模型在分层患者方面存在局限性，促使我们基于合并症评分研究基线合并症对总生存的影响。白蛋白水平（p=0.001）和肺部疾病（p=0.013）对预后有单一变量的影响。基线合并症负担是患者脆弱性的有力预测指标，与不良事件（尤其是感染）的发生率增加相关，并预测总生存（p<0.001）。
除了疾病生物学外，合并症负担也可能影响预后。虽然老年 AML 的治疗手段在不断改进，但综合 AML 生物学与针对患者脆弱性的个体化干预措施可能会充分发挥新型药物的抗白血病潜力。
