A retrospective survey was conducted in hematologic centres of the Rete Ematologica Lombarda (REL) on 529 older AML patients seen between 2020–2022. Compared to 2008–2016, the use of intensive chemotherapy (ICT) decreased from 40% to 18.1% and of hypomethylating agents (HMAs) from 19.5% to 13%, whereas the combination of Venetoclax/HMA, initially not available, increased from 0% to 36.7%. Objective treatment-specific fitness criteria proposed by SIE/SIES/GITMO in 2013 allow an appropriate choice between ICT and HMAs by balancing their efficacy and toxicity. Venetoclax/HMA, registered for patients unfit to ICT, has a unique toxicity profile because of prolonged granulocytopenia and increased infectious risk. Aiming at defining specific fitness criteria for the safe use of Venetoclax/HMA, a preliminary investigation was conducted among expert REL hematologists, asking for modifications of SIE/SIES/GITMO criteria they used to select candidates for Venetoclax/HMA. While opinions among experts varied, a general consensus emerged on restricting SIE/SIES/GITMO criteria for ICT-unfit patients to an age limit of 80–85, cardiac function > 40%, and absence of recurrent lung infections, bronchiectasis, or exacerbating COPD. Also, the presence of an adequate caregiver was considered mandatory. Such expert opinions may be clinically useful and may be considered when treatment-specific fitness criteria are updated to include Venetoclax/HMA.
伦巴第血液学网络（REL）对2020-2022年间收治的529例老年急性髓系白血病患者开展了一项回顾性研究。与2008-2016年相比，强化化疗（ICT）使用率从40%降至18.1%，低甲基化药物（HMAs）使用率从19.5%降至13%，而最初不可用的维奈托克/HMAs联合方案使用率从0%上升至36.7%。2013年SIE/SIES/GITMO提出的客观治疗特异性体能评估标准，通过平衡疗效与毒性，为ICT与HMAs的选择提供了恰当依据。针对不适合ICT患者注册使用的维奈托克/HMAs方案，因存在粒细胞减少持续时间延长及感染风险增加的特点，具有独特的毒性特征。为建立维奈托克/HMAs安全使用的特异性体能评估标准，研究者在REL血液学专家中开展初步调研，征询其对SIE/SIES/GITMO标准应用于维奈托克/HMAs候选者筛选的修订意见。尽管专家观点存在差异，但普遍共识认为：对不适合ICT患者应用SIE/SIES/GITMO标准时，应限定年龄在80-85岁以下、心功能＞40%、无反复肺部感染、支气管扩张或慢性阻塞性肺疾病急性加重史。同时，必须确保患者具备合格的照护者。这些专家意见具有临床参考价值，未来更新包含维奈托克/HMAs方案的治疗特异性体能评估标准时可予以考量。
肿瘤(癌症)患者之家