Inflammatory biomarkers, geriatric assessment, and treatment outcomes in acute myeloid leukemia
Inflammatory biomarkers, geriatric assessment, and treatment outcomes in acute myeloid leukemia
复制标题
DOI：
10.1016/j.jgo.2019.03.014
复制
发表时间：
2020-04-01
影响因子：
3
通讯作者：
Klepin, Heidi D.
中科院分区：
文献类型：
--
作者：
Loh, Kah Poh;Tooze, Janet A.;Klepin, Heidi D.
目的：研究老年急性髓系白血病（AML）患者诱导治疗期间炎症生物标志物的变化，以及它们与老年评估（GA）指标和预后的关联。
方法：这是一项针对前瞻性观察研究的单机构辅助研究（N = 20例连续的年龄≥60岁且新诊断为AML并接受诱导化疗的成年人）。在诱导开始时、每周一次共三周以及诱导后收集生物标志物（白细胞介素 - 6[IL - 6]、IL - 6可溶性受体[IL - 6 sR]、肿瘤坏死因子α[TNF - α]、TNF - α可溶性受体1[TNF - α sR1]、白细胞介素 - 3[IL - 3]、C - 反应蛋白[CRP]），并使用配对t检验比较不同时间点的情况。在基线和诱导后进行老年评估，并使用斯皮尔曼相关性分析与生物标志物水平相关联。使用卡普兰 - 迈耶方法估计生存率，并使用威尔科克森检验按生物标志物水平分类进行比较。
结果：除CRP和IL - 6 sR外，诱导期间生物标志物水平稳定。客观测量的身体功能下降[简易体能状况量表（SPPB）；r = 0.71，p < 0.01]以及自我报告的日常生活工具性活动受限增加（r = 0.81，p < 0.01）与TNF - α sR1增加相关。SPPB下降与CRP增加相关（r = - 0.73，p < 0.01）。抑郁改善与IL - 6 sR增加相关（r = - 0.59，p = 0.02）。基线TNF - α或CRP水平高于中位数的患者生存期较短（分别为6.1个月对40.2个月和5.5个月对27.6个月，两者p = 0.04）。
结论：在老年AML患者中，TNF - α sR1、CRP和IL - 6 sR与治疗期间身体和心理健康变化之间的关系值得进一步研究。（C）2019爱思唯尔有限公司。保留所有权利。
Objectives: To investigate changes in inflammatory biomarkers during induction therapy for older adults with acute myeloid leukemia (AML) and their associations with geriatric assessment (GA) measures and outcomes.Methods: This was a single institution ancillary study to a prospective observational study (N = 20 consecutive adults aged >= 60 with newly diagnosed AML who received induction chemotherapy). Biomarkers (Interleukin6 [IL-61. IL-6 soluble receptor [IL-6 sR], tumor necrosis Factor alpha [TNF alpha], TNF alpha soluble receptor 1 [TNF alpha sR1], interleukin-3 [IL-3], C-reactive protein [CRP]) were collected at start of induction, weekly for three weeks, and post-induction and were compared over time using paired t-tests. GA was administered at baseline and post-induction, and correlated with biomarker levels using Spearman correlations. Survival was estimated using Kaplan-Meier and compared by categorized biomarker level using Wilcoxon tests.Results: Biomarker levels were stable during induction, except for CRP and IL-6 sit Declines in objectively measured physical function [Short Physical Performance Battery (SPPB); r = 0.71, p < 0.01] and increases in self-reported limitation in instrumental activities of daily living (r = 0.81, p < 0.01) were correlated with increased TNF alpha sR1. Declines in SPPB were correlated with increased CRP (r = -0.73, p < 0.01). Improvement in depression was correlated with increased IL-6 sR (r = -0.59 p = 0.02). Survival was shorter in those with baseline TNF alpha or CRP levels above the median (6.1 vs. 40.2 months and 5.5 vs. 27.6 months respectively, p = 0.04 for both).Conclusion: Among older adults with AML the relationships between TNF alpha sR1, CRP, and IL-6 sR with change in physical and emotional health during treatment warrants further investigation. (C) 2019 Elsevier Ltd. All rights reserved.