Oñate Guadalupe, Garrido Ana, Arnan Montserrat, Pomares Helena, Alonso Ester, Tormo Mar, Diaz-Beya Marina, Vives Susana, Zamora Lurdes, Sampol Antonia, Coll Rosa, Salamero Olga, Cervera Marta, Garcia Antoni, Vall-Llovera Ferran, Garcia-Avila Sara, Bargay Joan, Ortin Xavier, Iranzo Eva, Guijarro Francisca, Pratcorona Marta, Nomdedeu Josep F, Esteve Jordi, Sierra Jorge
Hospital de la Santa Creu i Sant Pau. Institut d'investigació Biomèdica Sant Pau (IIB SANT PAU) Department of Medicine, Universitat Autonoma of Barcelona, Barcelona, Spain.
Institut Catala d'Oncologia, Hospital Duran i Reynals, Institut d'Investigacio Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, University of Barcelona, Barcelona, Spain.
Blood Cancer J. 2025 Jan 11;15(1):4. doi: 10.1038/s41408-024-01205-5.
Given the heterogeneity of acute myeloid leukemia patients, it is necessary to identify patients considered fit for intensive therapy but who will perform poorly, and in whom alternative approaches deserve investigation. We analyzed 1034 fit adults ≤70 years intensively treated between 2012 and 2022 in the CETLAM group. Young adults ( ≤ 60 years) presented higher remission rates and improved survival than older adults above that age (CR 79% vs. 73%; p = 0.03 and 4-yr OS 53% vs. 33%; p < 0.001). Remission and survival outcomes varied among different genetic subsets. An especially adverse genetic group included complex, monosomal karyotype, TP53 alterations (deleted/mutated), and MECOMr. Transplant feasibility in this very adverse risk group was low, and OS and EFS at 4 years were 14% and 12%, in contrast to 70% and 57% in the favorable group and 38% and 32% in all other patients. We integrated clinical and genetic data into the Intensive Chemotherapy Score for AML (ICSA) with 6-risk categories with significantly different remission rates and OS, validated in another cohort of 581 AML patients from a previous CETLAM protocol. In summary, we identified groups of fit patients that benefit differently from an intensive approach which may be helpful in future treatment decisions.
鉴于急性髓系白血病患者的异质性，有必要识别那些被认为适合强化治疗但预后不佳的患者，以及那些值得研究替代治疗方法的患者。我们分析了2012年至2022年期间在CETLAM组接受强化治疗的1034名年龄≤70岁的适合强化治疗的成年患者。年轻成年人（≤60岁）的缓解率更高，生存率也高于该年龄以上的老年人（完全缓解率79%对73%；p = 0.03，4年总生存率53%对33%；p < 0.001）。不同基因亚组的缓解和生存结果各不相同。一个特别不良的基因组包括复杂核型、单倍体核型、TP53改变（缺失/突变）和MECOMr。在这个非常高风险组中移植的可行性较低，4年总生存率和无事件生存率分别为14%和12%，而有利组分别为70%和57%，所有其他患者分别为38%和32%。我们将临床和基因数据整合到急性髓系白血病强化化疗评分（ICSA）中，该评分有6个风险类别，缓解率和总生存率有显著差异，并在另一组来自之前CETLAM方案的581名急性髓系白血病患者中得到验证。总之，我们识别出了不同的适合强化治疗的患者群体，他们从强化治疗中获益不同，这可能有助于未来的治疗决策。
