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85 岁以上老年患者行骨髓活检:不可或缺抑或纯属多余?一项回顾性分析。

Bone marrow biopsy in geriatric patients above the age of 85 years: invaluable or unnecessary? A retrospective analysis.

机构信息

Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Faculty of Medicine, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany.

Center for Integrated Oncology, Aachen Bonn Cologne Düsseldorf (CIO ABCD), Aachen, Germany.

出版信息

Ann Hematol. 2024 Apr;103(4):1149-1158. doi: 10.1007/s00277-024-05650-x. Epub 2024 Feb 10.

Abstract

Bone marrow biopsy (BMB) is a well-established diagnostic tool for various hematological, oncological, and other medical conditions. However, treatment options for geriatric patients (pts) facing these diseases are often constrained. In this single-center, retrospective analysis we assessed the diagnostic value of BMB in geriatric pts aged ≥ 85 years and examined its impact on therapeutic decisions. We examined 156 BMB procedures in 129 pts, extracting data from the electronic patient records and applying descriptive statistical methods. Nearly half of the primary diagnostic procedures (26; 44.1%) resulted in a modification of the initially suspected diagnosis. Notably, 15 (25.4%) of these procedures, led to changes in both the diagnosis and planned interventional treatment. Among the 15 follow-up procedures (36.6%), disease progression was initially suspected based on symptoms, but BMB results excluded such progression. In lymphoma staging biopsies, only 2 (3.6%) prompted a change in therapeutic intervention. Importantly, no BMB-related complications, such as bleeding, infection or nerve damage, were reported. Median survival after BMB was 16.1 months across all pts, yet it varied based on the diagnosis and comorbidity score. The survival of pts with a change in therapy based on BMB results did not significantly differ from those who did not undergo a therapy change. In conclusion, BMB proved to be generally safe and beneficial in this geriatric cancer patient cohort beyond the age of 85 years. However, the advantages of lymphoma staging in this patient population warrant further consideration.

摘要

骨髓活检 (BMB) 是一种广泛应用于各种血液学、肿瘤学和其他医学病症的诊断工具。然而,对于面临这些疾病的老年患者 (pts),治疗方案往往受到限制。在这项单中心回顾性分析中,我们评估了 BMB 在年龄≥85 岁的老年 pts 中的诊断价值,并研究了其对治疗决策的影响。我们从电子病历中提取数据,并采用描述性统计方法,对 129 名 pts 的 156 次 BMB 操作进行了检查。近一半的初次诊断性操作(26;44.1%)导致最初怀疑的诊断发生改变。值得注意的是,其中 15 次操作(25.4%)导致诊断和计划干预治疗的改变。在 15 次随访性操作(36.6%)中,疾病进展最初基于症状被怀疑,但 BMB 结果排除了这种进展。在淋巴瘤分期活检中,仅有 2 次操作(3.6%)促使治疗干预发生改变。重要的是,没有报告与 BMB 相关的并发症,如出血、感染或神经损伤。所有 pts 的 BMB 后中位生存时间为 16.1 个月,但根据诊断和合并症评分有所不同。基于 BMB 结果改变治疗方案的 pts 的生存时间与未进行治疗改变的 pts 没有显著差异。总之,BMB 在 85 岁以上的老年癌症患者群体中被证明是安全且有益的。然而,淋巴瘤分期在该患者群体中的优势需要进一步考虑。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5cd6/10940467/1ada1886eaa4/277_2024_5650_Fig1_HTML.jpg

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