Treatment choice according to the individual conditions remains challenging, particularly in older patients with acute myeloid leukemia (AML) and high risk myelodysplastic syndrome (MDS). The impact of performance status, comorbidities, and physical functioning on survival is not well defined for patients treated with hypomethylating agents. Here we describe the impact of performance status (14% ECOG performance status 2), comorbidity (40% HCT-comorbidity index ≥ 2), and physical functioning (41% short physical performance battery < 9 and 17% ADL index < 6) on overall survival (OS) in 115 older patients (age ≥ 66 years) treated on a clinical trial with a 10-day decitabine schedule. None of the patient-related variables showed a significant association with OS. Multivariable analysis revealed that age > 76 years was significantly associated with reduced OS (HR 1.58; p = 0.043) and female sex was associated with superior OS (HR 0.62; p = 0.06). We further compared the genetic profiles of these subgroups. This revealed comparable mutational profiles in patients younger and older than 76 years, but, interestingly, revealed significantly more prevalent mutated ASXL1, STAG2, and U2AF1 in male compared to female patients. In this cohort of older patients treated with decitabine age and sex, but not comorbidities, physical functioning or cytogenetic risk were associated with overall survival.
根据个体情况选择治疗方案仍然具有挑战性，尤其对于患有急性髓系白血病（AML）和高危骨髓增生异常综合征（MDS）的老年患者。体能状态、合并症及身体功能对接受去甲基化药物治疗患者生存的影响尚未明确。本研究通过115例老年患者（年龄≥66岁）的临床试验数据，分析了采用10天地西他滨方案治疗时，体能状态（14%患者ECOG体能状态评分为2）、合并症（40%患者HCT合并症指数≥2）及身体功能（41%患者简易体能测试<9分，17%患者日常生活活动指数<6分）对总生存期（OS）的影响。结果显示，上述患者相关变量均未与OS呈现显著关联。多变量分析表明，年龄>76岁与OS降低显著相关（风险比1.58；p=0.043），而女性与更优的OS相关（风险比0.62；p=0.06）。我们进一步比较了各亚组的遗传学特征，发现76岁以上与以下患者的基因突变谱相似，但值得注意的是，与女性患者相比，男性患者的ASXL1、STAG2和U2AF1基因突变发生率显著更高。在这组接受地西他滨治疗的老年患者中，年龄和性别与总生存期相关，而合并症、身体功能或细胞遗传学风险未显示关联。
肿瘤(癌症)患者之家