Results of intensive chemotherapy in 998 patients age 65 years or older with acute myeloid leukemia or high-risk myelodysplastic syndrome - Predictive prognostic models for outcome
Results of intensive chemotherapy in 998 patients age 65 years or older with acute myeloid leukemia or high-risk myelodysplastic syndrome - Predictive prognostic models for outcome
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DOI：
10.1002/cncr.21723
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发表时间：
2006-03-01
期刊：
影响因子：
6.2
通讯作者：
Estey, E
中科院分区：
文献类型：
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作者：
Kantarjian, H;O'Brien, S;Estey, E
背景患有急性髓性白血病（AML）的老年患者（年龄大于或等于65岁）通常预后不良。AML型治疗结果通常来自年轻患者的研究，可能不适用于老年AML。许多研究人员和肿瘤学家有时只提倡支持性治疗或一线单药治疗、I-II期研究、低强度治疗或“靶向”治疗。然而，老年AML患者接受“标准”AML型治疗的基线预期结果尚未明确。目的是建立老年AML患者完全缓解（CR）、诱导期（8周）死亡率和生存率的预后模型，用于建议肿瘤学家和患者对标准AML类型治疗的预期，并建立基线治疗结果，以评估新策略。分析了1980年至2004年期间接受强化化疗的998例年龄大于或等于65岁的AML或高危骨髓增生异常综合征（> 10%原始细胞）患者。采用标准方法对与CR、诱导期（8周）死亡率和生存率相关的预后因素进行单变量和多变量分析。总体CR率为45%，诱导期死亡率为29%。预后因素的多变量分析确定了CR、8周死亡率和生存率的一致独立预后不良因素。这些包括年龄≥ 75岁，不利的核型（通常复杂），表现不佳（3-4 ECOG [东部肿瘤协作组]），既往血液学疾病持续时间较长，层流室外治疗和器官功能异常。患者可分为：1）良好组（约20%的患者）预期CR率高于60%，诱导死亡率为10%，1年生存率高于50%; 2）中间组（约50-55%的患者），预期CR率为50%，诱导死亡率为30%，1年生存率为30%; 3）不良风险组（约25-30%的患者），预期CR率低于20%，诱导期死亡率高于50%，1年生存率低于10%。基于标准的现成基线特征，为老年AML患者开发了预后模型，这可能有助于治疗和研究决策。这些基于回顾性分析的预测模型需要在独立的研究小组中进行验证。
BACKGROUND. Elderly patients (age greater than or equal 65 years) with acute myeloid leukemia (AML) generally have a poor prognosis. AML-type therapy results are often derived from studies in younger patients and may not apply to elderly AML. Many investigators and oncologists advocate, at times, only supportive care or frontline single agents, Phase I-II studies, low-intensity regimens, or 'targeted' therapies. However, baseline expectations for outcomes of elderly AML with 'standard' AML-type therapy are not well defined. The aim was to develop prognostic models for complete response (CR), induction (8-week) mortality, and survival rates in elderly AML, which would be used to advise oncologists and patients of expectations with standard AML type therapy, and to establish baseline therapy results against which novel strategies would be evaluated.METHODS. A total of 998 patients age greater than or equal to 65 years with AML or high-risk myelodysplastic syndrome (> 10% blasts) treated with intensive chemotherapy between 1980 and 2004 were analyzed. Univariate and multivariate analyses of prognostic factors associated with CR, induction (8-week) mortality, and survival used standard methods.RESULTS. The overall CR rate was 45% and induction mortality 29%. Multivariate analysis of prognostic factors identified consistent independent poor prognostic factors for CR, 8-week mortality, and survival. These included age >= 75 years, unfavorable karyotypes (often complex), poor performance (3-4 ECOG [Eastern Cooperative Oncology Group]), longer duration of antecedent hematologic disorder, treatment outside the laminar airflow room, and abnormal organ functions. Patients could be divided into: 1) a favorable group (about 20% of patients) with expected CR rates above 60%, induction mortality rates of 10%, and 1-year survival rates above 50%; 2) an intermediate group (about 50-55% of patients) with expected CR rates of 50%, induction mortality rates of 30%, and 1-year survival rates of 30%; and 3) an unfavorable risk group (about 25-30% of patients) with expected CR rates of less than 20%, induction mortality rates above 50%, and 1-year survival rates of less than 10%.CONCLUSIONS. Prognostic models, based on standard readily available baseline characteristics, were developed for elderly patients with AML, which may assist in therapeutic and investigational decisions. These predictive models, based on a retrospective analysis, will require validation in independent study groups.