Chronic kidney disease (CKD) before treatment and renal function decline during treatment are common in elderly patients receiving hypomethylating agents (HMAs) and venetoclax (VEN). This retrospective multicenter study of 130 newly diagnosed older acute myeloid leukemia (AML) patients evaluated the prognostic impact of renal function before and during the first treatment cycle. A total of 56 patients (43%) had CKD, and 49 (38%) developed acute kidney injury (AKI) during treatment. AKI occurrence was associated with laboratory tumor lysis syndrome (LTLS). CKD before treatment showed a trend towards a lower overall response rate (ORR, OR 0.5,p= 0.07) in multivariable analysis (MVA) and inferior relapse-free survival (RFS, HR 2.16,p= 0.06) in univariate analysis (UVA), but not MVA (RFS, HR 1.93,p= 0.15). CKD did not affect overall survival (OS) or event-free survival (EFS). AKI during HMA/VEN therapy was associated with significantly higher 30-day and 60-day mortality rates and emerged as an independent prognostic factor for inferior OS (HR 1.86,p= 0.01) and EFS (HR 1.81,p= 0.007). RFS did not differ significantly by AKI status. Sepsis was a more frequent cause of death in patients with vs. without AKI (33% vs. 5%). In conclusion, kidney function is a key prognostic factor in HMA/VEN-treated patients, warranting further study on treatment adjustments and supportive care.
在接受低甲基化药物（HMAs）和维奈托克（VEN）治疗的老年患者中，治疗前存在的慢性肾脏病（CKD）以及治疗期间肾功能下降较为常见。这项回顾性多中心研究纳入了130名新诊断的老年急性髓系白血病（AML）患者，评估了首个治疗周期前后肾功能对预后的影响。共有56名患者（43%）存在CKD，49名患者（38%）在治疗期间发生了急性肾损伤（AKI）。AKI的发生与实验室肿瘤溶解综合征（LTLS）相关。多变量分析（MVA）显示，治疗前CKD与较低的总缓解率（ORR，OR 0.5, p=0.07）存在关联趋势；单变量分析（UVA）显示其与较差的的无复发生存期（RFS, HR 2.16, p=0.06）相关，但在MVA中未达统计学意义（RFS, HR 1.93, p=0.15）。CKD不影响总生存期（OS）或无事件生存期（EFS）。然而，HMA/VEN治疗期间发生的AKI与显著更高的30天和60天死亡率相关，并且是OS（HR 1.86, p=0.01）和EFS（HR 1.81, p=0.007）较差的独立预后因素。AKI状态不同的患者，其RFS无显著差异。与未发生AKI的患者相比，发生AKI的患者因败血症死亡的比例更高（33% vs. 5%）。总之，肾功能是接受HMA/VEN治疗患者的关键预后因素，值得进一步研究治疗调整和支持性护理策略。
肿瘤(癌症)患者之家