Superior outcome with hypomethylating therapy in patients with acute myeloid leukemia and high-risk myelodysplastic syndrome and chromosome 5 and 7 abnormalities.
Superior outcome with hypomethylating therapy in patients with acute myeloid leukemia and high-risk myelodysplastic syndrome and chromosome 5 and 7 abnormalities.
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DOI：
10.1002/cncr.24661
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发表时间：
2009-12-15
期刊：
影响因子：
6.2
通讯作者：
Kantarjian, Hagop
中科院分区：
文献类型：
--
作者：
Ravandi, Farhad;Issa, Jean-Pierre;Garcia-Manero, Guillermo;O'Brien, Susan;Pierce, Sherry;Shan, Jianqin;Borthakur, Gautam;Verstovsek, Srdan;Faderl, Stefan;Cortes, Jorge;Kantarjian, Hagop
伴有5号和7号染色体异常的急性髓性白血病（AML）和高危骨髓增生异常综合征（MDS）患者[不包括del 5(q)]的预后很差，不到10%的患者在2年时存活。我们调查了使用低甲基化药物（5-氮杂胞苷/地西他滨）治疗是否能改善结果。2004年1月至2007年12月，81例患者[37例（46%）急性髓性白血病（≥20%）；44例（54%）5号和7号染色体异常的高危MDS患者以低甲基化药物作为初始治疗。其中包括68例复杂（≥3）异常患者和13例少于3例异常患者。同期，151例5号和7号染色体异常患者（126例AML， 25例MDS）（128例复杂，23例非复杂）接受了强化化疗（包括72%的阿糖胞苷为基础的方案，28%的其他方案）。两组患者的中位年龄分别为66岁和61岁[范围（37-85）和（19-89）]。低甲基化组33例（41%）患者达到CR，化疗组53例（35%）患者达到CR （p=0.395）。中位随访时间为51周（12 - 101周）和40周（5-128周），低甲基化组22/33例患者和化疗组33/53例患者复发。中位CR持续时间分别为45周和23周（p=0.153）。低甲基化组的总生存期优于化疗组（p=0.019）。对于5号和7号染色体异常的患者，使用低甲基化药物治疗可能优于化疗。
Outcome of patients with acute myeloid leukemia (AML) and high-risk myelodysplastic syndrome (MDS) with chromosome 5 and 7 abnormalities [excluding del 5(q)] has been poor with fewer than 10% of patients alive at 2 years. We investigated whether treatment with hypomethylating agents (5-azacytidine/decitabine) leads to an improved outcome. Between January 2004 and December 2007, 81 patients [37 (46%) with AML (≥ 20% blast); 44 (54%) with high-risk MDS] with chromosome 5 and 7 abnormalities were treated with hypomethylating agents as their initial therapy. These included 68 patients with complex (≥ 3) abnormalities and 13 with less than 3 aberrations. During the same period, 151 patients (126 with AML, 25 with MDS) with chromosome 5 and 7 abnormalities (128 complex, 23 non-complex) were treated with intensive chemotherapy (including cytarabine based regimens in 72% and other in 28%). Median ages for the two groups were 66 and 61 years, respectively [(ranges (37–85) and (19–89)]. Thirty three (41%) patients in the hypomethylating group achieved CR versus 53 (35%) in the chemotherapy group (p=0.395). With a median follow up of 51 weeks (range 12 – 101) and 40 weeks (range, 5–128), 22/33 patients in the hypomethylating group and 33/53 patients in the chemotherapy group have relapsed. The median CR duration was 45 weeks and 23 weeks, respectively (p=0.153). The overall survival was superior for the hypomethylating group compared to the chemotherapy group (p=0.019). Treatment with hypomethylating agents may be superior to chemotherapy in patients with chromosome 5 and 7 abnormalities.
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影响因子：
20.3
作者：
Garcia-Manero, Guillermo;Kantarjian, Hagop M.;Issa, Jean-Pierre
通讯作者：
Issa, Jean-Pierre
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20.3
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