Parameters detected by geriatric and quality of life assessment in 195 older patients with myelodysplastic syndromes and acute myeloid leukemia are highly predictive for outcome
Parameters detected by geriatric and quality of life assessment in 195 older patients with myelodysplastic syndromes and acute myeloid leukemia are highly predictive for outcome
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DOI：
10.3324/haematol.2012.067892
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发表时间：
2013-02-01
期刊：
影响因子：
10.1
通讯作者：
Luebbert, Michael
中科院分区：
文献类型：
--
作者：
Deschler, Barbara;Ihorst, Gabriele;Luebbert, Michael
骨髓增生异常综合征和急性髓性白血病体现了老年患者治疗分配的复杂性，选择范围从最佳支持治疗、非强化治疗（例如低甲基化药物）到强化化疗/造血细胞移植。迫切需要非疾病变量的新指标来帮助为每位老年患者确定最佳治疗方案。我们在 195 名 60 岁或以上患有骨髓增生异常综合征/急性髓系白血病的患者中，除了已确定的疾病特异性变量之外，还研究了老年/生活质量评估的可行性和预后价值。这些患者根据治疗强度进行分组并进行评估。评估包括八项工具，评估日常生活活动、抑郁、心理功能、活动能力、合并症、卡诺夫斯基指数和生活质量。中位年龄为 71 岁（范围 60-87 岁）的骨髓增生异常综合征 (n=63) 或急性髓系白血病 (n=132) 患者接受最佳支持治疗 (n=47)、低甲基化药物 (n=73) 或强化化疗/造血细胞移植 (n=75) 治疗。选择变量后，日常生活的病理活动和生活质量/疲劳仍然对整个患者组的总体生存具有高度预测性，除了疾病相关的危险因素、不良细胞遗传学和原始细胞计数为 20% 或以上之外。在 107 名接受非强化日常生活活动治疗的患者中，低于 100 的日常生活活动（风险比，HR 2.94）、卡诺夫斯基指数低于 80（HR 2.34）和生活质量/“疲劳”为 50 或以上（HR 1.77）是重要的预测因素。不良特征的总结显示死亡风险很高（HR 9.36）。在分配个体治疗之前对老年患者进行深入评估是可行的，并为标准评估提供了额外的信息。年龄在 60 岁或以上、新诊断出骨髓增生异常综合征/急性髓系白血病且日常生活活动受损、卡诺夫斯基指数低于 80%、生活质量/“疲劳”为 50 或以上的患者可能会出现不良预后。
Myelodysplastic syndromes and acute myeloid leukemia exemplify the complexity of treatment allocation in older patients as options range from best supportive care, non-intensive treatment (e. g. hypomethylating agents) to intensive chemotherapy/hematopoietic cell transplantation. Novel metrics for non-disease variables are urgently needed to help define the best treatment for each older patient. We investigated the feasibility and prognostic value of geriatric/quality of life assessments aside from established disease-specific variables in 195 patients aged 60 years or over with myelodysplastic syndromes/acute myeloid leukemia. These patients were grouped according to treatment intensity and assessed. Assessment consisted of eight instruments evaluating activities of daily living, depression, mental functioning, mobility, comorbidities, Karnofsky Index and quality of life. Patients with a median age of 71 years (range 60-87 years) with myelodysplastic syndromes (n=63) or acute myeloid leukemia (n=132) were treated either with best supportive care (n=47), hypomethylating agents (n=73) or intensive chemotherapy/hematopoietic cell transplantation (n=75). After selection of variables, pathological activities of daily living and quality of life/fatigue remained highly predictive for overall survival in the entire patient group beyond disease-related risk factors adverse cytogenetics and blast count of 20% or over. In 107 patients treated non-intensively activities of daily living of less than 100 (hazard ratio, HR 2.94), Karnofsky Index below 80 (HR 2.34) and quality of life/'fatigue' of 50 or over (HR 1.77) were significant prognosticators. Summation of adverse features revealed a high risk of death (HR 9.36). In-depth evaluation of older patients prior to individual treatment allocation is feasible and provides additional information to standard assessment. Patients aged 60 years or over with newly diagnosed myelodysplastic syndromes/acute myeloid leukemia and impairments in activities of daily living, Karnofsky Index below 80%, quality of life/'fatigue' of 50 or over, are likely to have poor outcomes.