Treatment options for patients with acute myeloid leukemia with a matched sibling donor - A decision analysis
Treatment options for patients with acute myeloid leukemia with a matched sibling donor - A decision analysis
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DOI：
10.1002/cncr.11098
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发表时间：
2003-02-01
期刊：
影响因子：
6.2
通讯作者：
Detsky, AS
中科院分区：
文献类型：
--
作者：
Sung, L;Buckstein, R;Detsky, AS
背景资料。异基因骨髓移植(BMT)在巩固年轻的急性髓系白血病(AML)与匹配的同胞供者(MSD)中的作用是有争议的。虽然与强化化疗(CT)巩固相比，骨髓移植与增加无事件生存率有关，但骨髓移植也与治疗相关的死亡率增加以及那些没有复发疾病的患者的生活质量和预期寿命降低有关。方法：作者使用决策分析比较了三种最大化首次缓解的急性髓细胞白血病患者的质量调整寿命年(QALY)的策略：骨髓移植ALL、BMT NONE(仅巩固CT)或BMT在高危患者中，如基线细胞遗传学测试(测试策略)所定义的那样。然后构建第二个决策分析树，将BMT和CT专门用于中等细胞遗传学患者。结果使用预期QALY作为结果度量，测试、BMT ALL和BMT NONE策略分别与20.10个QALY、19.63个QALY和18.38个QALY相关。因此，CT用于低风险患者，BMT用于中风险和高风险患者的测试策略被认为是最佳策略。在中间细胞遗传学决策分析中，尽管接受BMT的患者的预期QALY高于接受CT的患者(19.78个QALY和18.75个QALY)，但由于变量估计的不确定性，最佳选择不太清楚。结论：对于细胞遗传学良好的AML患者，即使有MSD，CT合并也是一个合理的选择。这个模型提供了一个框架，AML患者和他们的医生可以从这个框架中做出关于巩固治疗的决定。癌症杂志2003；97：592-600。(C)2003年美国癌症协会。
BACKGROUND. The role of allogeneic bone marrow transplantation (BMT) in the consolidation of young adults with acute myeloid leukemia (AML) with matched sibling donors (MSD) is controversial. Although BMT is associated with increased event free survival compared with intensive chemotherapy (CT) consolidation, BMT also is associated with increased treatment-related mortality and likely decreased quality of life and life expectancy in patients who do not develop recurrent disease.METHODS. The authors used decision analysis to compare three strategies for maximizing quality- adjusted life years (QALYs) in patients with AML in first remission with an MSD: BMT All, BMT None (consolidation CT only), or BMT in high-risk patients, as defined by baseline cytogenetic testing (Test strategy). A second decision-analysis tree was then constructed that compared BMT with CT specifically for patients with intermediate cytogenetics.RESULTS. Using expected QALYs as the outcome measure, the Test, BMT All, and BMT None strategies were associated with 20.10 QALYs, 19.63 QALYs, and 18.38 QALYs, respectively. Thus, the Test strategy, with CT for low-risk patients and BMT for intermediate risk and high-risk patients, was expected to be the optimal strategy. In the intermediate cytogenetic decision analysis, although the expected QALY for BMT recipients was higher compared with CT recipients (19.78 QALYs vs. 18.75 QALYs), because of uncertainty in variable estimates, the optimal choice was less clear.CONCLUSIONS. CT consolidation is a reasonable option for patients with AML who have favorable cytogenetics, even if an MSD is available. This model provides a framework from which patients with AML and their physicians can make decisions about consolidation therapy. Cancer 2003;97:592-600. (C) 2003 American Cancer Society.