Outcomes after induction chemotherapy in patients with acute myeloid leukemia arising from myelodysplastic syndrome.
Outcomes after induction chemotherapy in patients with acute myeloid leukemia arising from myelodysplastic syndrome.
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DOI：
10.1002/cncr.25598
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发表时间：
2011-04-01
期刊：
影响因子：
6.2
通讯作者：
Lancet JE
中科院分区：
文献类型：
--
作者：
Bello C;Yu D;Komrokji RS;Zhu W;Wetzstein GA;List AF;Lancet JE
继发于骨髓增生异常综合征（MDS）/骨髓增生性肿瘤的继发性急性髓性白血病（AML）预后不良。作者评价了接受蒽环类药物诱导治疗的继发性AML患者的预测因素。这是对接受诱导治疗的继发性AML患者的回顾性审查。评估了年龄、国际预后评分系统、东部肿瘤协作组体力状态、细胞遗传学、MDS/骨髓增生性肿瘤持续时间和既往MDS/骨髓增生性肿瘤治疗对完全缓解（CR）、低血小板CR和总生存期（OS）的影响。作者评价了61例接受诱导化疗的继发性AML患者; 59%（36例患者）达到CR/CR伴低血小板（95%置信区间[CI]，46%-71%），中位OS为6.5（95% CI，3.9-8.1）个月。有三个因素与低CR/CR伴低血小板和OS相关：细胞遗传学风险差、既往接受过低甲基化药物或来那度胺治疗以及转化为AML的时间较长。在接受低甲基化药物或来那度胺治疗的患者中，32%的患者在血小板减少的情况下达到CR/CR，而未接受低甲基化药物或来那度胺治疗的患者为78%（比值比[OR]，0.13; 95%CI，0.04-0.42）。接受低甲基化药物或来那度胺治疗的患者的中位OS为3.7个月，而未接受低甲基化药物或来那度胺治疗的患者的中位OS为10.5个月（P < .0001）。细胞遗传学中度风险患者的CR/CR伴低血小板率为70%，而低风险患者的CR/CR伴低血小板率为35%（OR，4.33; 95%CI，1.38-13.6）。细胞遗传学风险低的患者的中位OS为2.8个月，中度风险的患者为7.5个月（P = 0.01）。既往接受过低甲基化药物或来那度胺治疗、细胞遗传学风险差和转化为AML的时间较长是诱导治疗后继发性AML患者缓解和OS的独立阴性预测因素。
Secondary acute myeloid leukemia (AML) from an antecedent myelodysplastic syndrome (MDS)/myeloproliferative neoplasm is associated with a poor prognosis. The authors evaluated predictive factors in patients with secondary AML treated with anthracycline-based induction therapy. This was a retrospective review of secondary AML patients treated with induction therapy. Age, International Prognostic Scoring System, Eastern Cooperative Oncology Group performance status, cytogenetics, duration of MDS/myeloproliferative neoplasm, and prior MDS/myeloproliferative neoplasm treatment were evaluated for their impact on complete response (CR), CR with low platelets, and overall survival (OS). The authors evaluated 61 secondary AML patients who received induction chemotherapy; 59% (36 patients) achieved CR/CR with low platelets (95% confidence interval [CI], 46%–71%), and median OS was 6.5 (95% CI, 3.9–8.1) months. Three factors were associated with lower CR/CR with low platelets and OS: poor risk cytogenetics, prior treatment with hypomethylating agents or lenalidomide, and longer time to transformation to AML. Of those treated with hypomethylating agents or lenalidomide, 32% achieved CR/CR with low platelets versus 78% in the group not treated with a hypomethylating agent or lenalidomide (odds ratio [OR], 0.13; 95% CI, 0.04–0.42). Median OS for those treated with a hypomethylating agent or lenalidomide was 3.7 versus 10.5 months for those not treated with a hypomethylating agent or lenalidomide (P < .0001). The CR/CR with low platelets rate for those with intermediate risk cytogenetics was 70% versus 35% for those with poor risk (OR, 4.33; 95% CI, 1.38–13.6). Those with poor risk cytogenetics had a median OS of 2.8 versus 7.5 months for those with intermediate risk (P = .01). Prior treatment with hypomethylating agents or lenalidomide, poor risk cytogenetics, and longer time to transformation to AML are independent negative predictive factors for response and OS in patients with secondary AML after induction therapy.