Outcomes of patients with myelodysplastic syndromes who achieve stable disease after treatment with hypomethylating agents.
Outcomes of patients with myelodysplastic syndromes who achieve stable disease after treatment with hypomethylating agents.
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脊髓增生性综合征患者的结局在甲基化剂治疗后达到稳定的疾病。
DOI：
10.1016/j.leukres.2015.12.007
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发表时间：
2016-02
影响因子：
2.7
通讯作者：
MDS Clinical Research Consortium
中科院分区：
文献类型：
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作者：
Nazha A;Sekeres MA;Garcia-Manero G;Barnard J;Al Ali NH;Roboz GJ;Steensma DP;DeZern AE;Zimmerman C;Jabbour EJ;Zell K;List AF;Kantarjian HM;Maciejewski JP;Komrokji RS;MDS Clinical Research Consortium
低甲基化药物（HMA）治疗可改善达到疾病稳定（SD）或更佳缓解（完全缓解[CR]、部分缓解[PR]或血液学改善[HI]）的患者的总生存期（OS）。对于在治疗4-6个月时达到SD的患者，是否应提供不同的治疗以优化其缓解或继续使用相同的方案，目前尚未明确。临床数据来自MDS临床研究联盟数据库。SD定义为无进展证据且未达到任何其他缓解。在接受AZA或DAC治疗的291例患者中，55%在4-6个月时达到最佳缓解（BR）。在4-6个月时SD的患者中，29例（20%）在较晚的治疗时间点获得了更好的缓解。具有较低骨髓原始细胞百分比和根据IPSS-R的中等风险的年轻患者更有可能在SD后4-6个月获得更好的缓解（CR、PR或HI）。随后达到CR的SD患者的OS优于保持SD的患者（分别为28.1 vs. 14.4个月，p = 0.04）。总之，接受HMA治疗的患者在SD状态后达到CR，6个月后连续治疗的生存期更长。
Treatment with hypomethylating agents (HMAs) improves overall survival (OS) in patients who achieve a response of stable disease (SD) or better (complete remission [CR], partial remission [PR], or hematologic improvement [HI]). It is not well established if patients who achieve SD at 4–6 months of therapy should be offered different therapies to optimize their response or continue with the same regimen. Clinical data were obtained from the MDS Clinical Research Consortium database. SD was defined as no evidence of progression and without achievement of any other responses. Of 291 patients treated with AZA or DAC, 55% achieved their best response (BR) at 4–6 months. Among patients with SD at 4–6 months, 29 (20%) achieved a better response at a later treatment time point. Younger patients with lower bone marrow blast percentages, and intermediate risk per IPSS-R were more likely to achieve a better response (CR, PR, or HI) after SD at 4–6 months. Patients with SD who subsequently achieved CR had superior OS compared to patients who remained with SD (28.1 vs. 14.4 months, respectively, p =.04). In conclusion, patients treated with HMAs who achieves CR after a SD status had longer survival with continuous treatment after 6 months.