缺乏营养状况在老年人中的标准AML风险评估中占优势
Laura Simon1, Alexis Caulier2, Céline Berthon3
1Service d'Hématologie Clinique et Thérapie cellulaire, Centre Hospitalier Universitaire d'Amiens, Amiens, France.
患有急性髓性白血病 (AML) 的老年人治疗选择有限. 这项研究发现,5-azacitidine (5-AZA) 在真实世界的数据中显示出比低剂量cytarabine (LDAC) 更好的整体存活率,尽管长期的结果类似.
科学领域:
- 血液学 血液学 血液学
- 老年瘤学 老年瘤学
- 临床药理学 临床药理学
背景情况:
- 患有急性髓性白血病 (AML) 的老年人往往由于虚弱而预后不佳.
- 密集化疗对于这一群体来说往往是不可行的.
- 目前的建议包括5-azacitidine (5-AZA) 或低剂量cytarabine (LDAC),有或没有venetoclax.
研究的目的:
- 评估老年AML患者接受一线5-AZA或LDAC的现实反应率和治疗结果.
- 在这个特定的患者群体中确定预后因素.
主要方法:
- 对279名患有AML的老年人进行了回顾性多中心注册研究.
- 在2009-2019年期间,患者接受了LDAC (n=87) 或5-AZA (n=192) 的一线治疗.
- 分析完全缓解率,整体存活率 (OS) 和预后因素.
主要成果:
- 总体而言,完全缓解率为27.3%.
- 与LDAC (4.8个月) 相比,5-AZA的中位数寿命更长 (8.9个月),p=0.046,但长期寿命率相似 (HR 1.37 [0.92-2.04],p=0.12).
- 低白蛋白 (<30 g/L) 是30日死亡率和生存率的唯一显著预测因素.
结论:
- 在现实环境中,5-AZA可能会在老年AML患者中比LDAC提供生存益处,尽管长期生存可能是可比的.
- 对于年轻的AML患者来说,传统的预后标记在老年人中没有预测力.
- 血清白蛋白水平是接受低甲基化剂或LDAC的老年AML患者的关键预后指标.
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