Background:The AML60+ score has been proposed for risk stratification in intensively treated elderly patients with acute myeloid leukemia (AML) or high-risk myelodysplastic neoplasms (MDS). Its prognostic impact in patients treated with hypomethylating agents (HMA) is unknown.Methods:Patients ≥ 60 years of age diagnosed with AML or MDS/AML according to ICC2022 were eligible for this retrospective and multicenter chart review if they had received at least one cycle of HMA-based treatment.Results:A cohort of 142 patients was analyzed. During follow-up (median 8 months), 114 patients died. The molecular Prognostic Score (mPRS) was available for 121 patients, the European Leukemia Net (ELN) 2022 classification for 117 patients, and the AML60+ for 105 patients. According to AML60+, 33 patients (31.4%) were classified as very poor risk, 36 (34.3%) as poor risk, and 34 (32.4%) as intermediate risk. Two patients (1.9%) were classified as favorable. Median overall survival (OS) was 21.7 months (mo) for the combined intermediate/favorable group, 7 mo for the poor risk group and 3 mo for the very poor risk group (p< 0.0001). Cox regression analysis (reference category: very poor) showed a significantly lower risk of death for both intermediate/favorable risk patients (HR 0.17, 95% CI 0.10–0.31,p< 0.001) and poor risk patients (HR 0.47, 95% CI 0.28–0.78,p= 0.004). The concordance score was 0.67 for AML60+, 0.60 for mPRS, and 0.58 for ELN2022.Conclusions:The AML60+ may represent a useful prognostic tool for elderly AML patients treated with HMA-based therapies. In particular, it could help to identify a group with a relatively favorable prognosis that is not clearly identified by the ELN2022 or the mPRS risk classification. However, analyses of larger cohorts are necessary to confirm our findings.
背景：AML60+评分系统已被提出用于接受强化治疗的老年急性髓系白血病（AML）或高危骨髓增生异常肿瘤（MDS）患者的风险分层。但其在接受低甲基化药物（HMA）治疗患者中的预后影响尚不明确。 方法：本研究为回顾性多中心病历审查，纳入年龄≥60岁、根据ICC2022标准诊断为AML或MDS/AML、且至少接受过一个周期HMA为基础治疗的患者。 结果：共分析142例患者。中位随访8个月期间，114例患者死亡。其中121例患者可获得分子预后评分（mPRS），117例可获得欧洲白血病网（ELN）2022分类，105例可获得AML60+评分。根据AML60+评分，33例（31.4%）患者被归为极高风险组，36例（34.3%）为高风险组，34例（32.4%）为中风险组，2例（1.9%）为低风险组。中位总生存期（OS）在中/低风险联合组为21.7个月，高风险组为7个月，极高风险组为3个月（p<0.0001）。Cox回归分析（以极高风险组为参照）显示，中/低风险组（HR 0.17，95% CI 0.10–0.31，p<0.001）和高风险组（HR 0.47，95% CI 0.28–0.78，p=0.004）的死亡风险均显著降低。AML60+、mPRS和ELN2022评分系统的一致性指数分别为0.67、0.60和0.58。 结论：AML60+评分系统可能成为接受HMA治疗的老年AML患者有效的预后评估工具。特别是它有助于识别ELN2022或mPRS风险分类未能明确界定的、具有相对良好预后的患者亚群。但需要更大规模队列分析以验证本研究结果。
肿瘤(癌症)患者之家