A Decision analysis to determine the appropriate treatment for low-risk myelodysplastic syndromes.
A Decision analysis to determine the appropriate treatment for low-risk myelodysplastic syndromes.
复制标题
决策分析以确定低风险骨髓增生异常综合征的适当治疗方法。
DOI：
10.1002/cncr.22497
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发表时间：
2007
期刊：
影响因子：
6.2
通讯作者：
Kattan,MichaelW
中科院分区：
文献类型：
--
作者：
Sekeres,MikkaelA;Fu,AlexZ;Maciejewski,JaroslawP;Golshayan,Ali-Reza;Kalaycio,MattE;Kattan,MichaelW
背景骨髓增生异常综合征（MDS）分为低危和高危疾病。基于红细胞输血需求和促红细胞生成素水平，已经开发了对生长因子（GF）反应的预测模型。对于低风险MDS，基于对NGF和GF的应答率和生存率的最佳初始治疗（GF vs非生长因子[NGF]治疗，包括分化和免疫调节剂）尚未确定。方法对799例接受GF或NGF治疗的低风险MDS患者进行马尔可夫决策分析，以确定合适的初始治疗方案。分析的治疗策略包括初始GF或NGF治疗，假设3种不同的状态：患者处于GF良好预测组（低输血需求和低促红细胞生成素水平），中等或差GF预测组（高输血需求和高促红细胞生成素水平）。结果在GF良好预测组中，与NGF治疗相比，GF初始治疗可改善典型MDS患者的生存期，前者为3.38年，后者为2.57年。当NGF治疗在≥46%的患者中产生应答时，GF对NGF的优势就丧失了。在中度或较差GF预测组中，每个预测组的NGF应答率分别为0.14%和4%，NGF最大化了生存率。生活质量调整并没有改变首选策略。结论：模型估计表明，GF预测良好组的患者几乎都应该接受GF治疗，而中度和较差预测组的患者几乎都应该接受NGF治疗。Cancer 2007©2007美国癌症协会。
BACKGROUNDThe myelodysplastic syndromes (MDS) are divided into low‐risk and high‐risk diseases. Predictive models for response to growth factors (GF) have been developed based on red blood cell transfusion needs and erythropoietin levels. For low‐risk MDS the optimal initial therapy (GF vs nongrowth factor [NGF] therapies, including differentiation and immunomodulatory agents) based on response rates to NGF and GF and survival, has not been defined.METHODSA Markov decision analysis was performed on 799 low‐risk MDS patients treated with either GF or NGF to determine the appropriate initial therapy. The treatment strategies analyzed included initial GF or NGF therapies, assuming 3 different states: Patients were either in the good GF predictive group (low transfusion needs and low erythropoietin levels), intermediate, or the poor GF predictive group (high transfusion needs and high erythropoietin levels).RESULTSIn the good GF predictive group, initial therapy with GF improved survival compared with NGF therapies at 3.38 years vs 2.57 years for a typical MDS patient. The advantage of GF to NGF was lost when NGF therapies produced a response in ≥46% of patients. In the intermediate or poor GF predictive groups, NGF maximized survival, provided response rates for NGF were >14% and 4%, respectively, for each predictive group. Quality of life adjustment did not alter the preferred strategy.CONCLUSIONSModeling estimates suggest that patients who fall into a good GF predictive group should almost always receive GF initially, whereas those in intermediate and poor predictive groups should almost always be treated with NGF. Cancer 2007 © 2007 American Cancer Society.