Prognostički faktori kod starijih bolesnika sa akutnom mijeloidnom leukemijom

Anka Poštić; Marijana  Virijević

doi:10.5937/smclk2-32394

Anka Poštić Klinika za pulmologiju, Univerzitetski klinički centar Srbije
Marijana Virijević Klinika za hematologiju, Univerzitetski klinički centar Srbije

DOI: https://doi.org/10.5937/smclk2-32394

Ključne reči: akutna mijeloidna leukemija, stariji, ukupno preživljavanje, prognostički faktori

Sažetak

Uvod: Akutna mijeloidna leukemija (AML) predstavlja patološku proliferaciju ćelija mijeloidne loze. Predominantno se javlja kod pacijenata starijih od 60 godina, sa značajno lošijim ishodom lečenja u poređenju sa mlađima.

Cilj: Analiza i uticaj kliničkih karakteristika starijih bolesnika sa AML na postizanje kompletne remisije (KR), ukupno preživljavanje (OS), ranu smrtnost (EM) i recidiv bolesti.

Materijali i metode: Retrospektivna studija koja obuhvata 94 pacijenta sa AML, nakon primene hemioterapije i palijativne terapije, čiji podaci su preuzeti iz istorije bolesti. Ispitivani faktori rizika za OS, KR, recidiv bolesti i EM bili su leukociti, nivo serumske laktat dehidrogenaze (LDH), opšte funkcionalno stanje prema ECOG (Eastern Cooperative Oncology Group) skali, European LeukemiaNet citogenetska grupa rizika, komorbiditetni indeks- HCT-CI (hematopoetic cell transplantation- comorbidity index) i NPM1/FLT3-ITD (Nukleofosmin/FLT3-internal tandem mutation) molekularni status. Za identifikaciju prognostičkih faktora korišćena je Coxova regresiona analiza.

Rezultati: Prosečna starost pacijenata iznosila je 69 godina (opseg: 65-87). KR je postiglo 23 (24,5%) pacijenata od 50 (53,2%) koji su primili intenzivnu hemioterapiju, pri čemu je do relapsa je došlo kod 17/24 (70,8%). EM je zabeležena kod 17 (18,1%) pacijenata. Pacijenti sa ECOG PS > 2 imali su statistički značajno lošije OS u odnosu na pacijente sa ECOG PS < 2 (p=0,030). Pacijenti sa HCT-CI > 3 imali su lošiji OS u odnosu na pacijente sa HCT-CI < 3 (p=0,040). Nivo LDH > 450 U/I pokazao se kao loš prognostički faktor za OS u odnosu na LDH < 450 U/I (p=0,044).

Zaključak: Stariji AML pacijenti sa lošijim funkcionalnim opštim stanjem po ECOG skali, visokim HCT-CI i povećanim nivoom LDH imaju lošije OS.

Reference

1. Janković G. Akutna mijeloblastna leukemija. U: Ćolović M, Janković G. Maligne bolesti krvi. Beograd, Zavod za udžbenike i nastavna sredstva, 1999: 81-119.
2. Ries LAG, Melbert D, Krapcho M, et al. SEER Cancer Statistics Review, 1975-2005. SEER Database, National Cancer Institute; 2009.
3. Hiddeman W, Kern W, Schoch C, et al. Management of acute myeloid leukemia in elderly patients. J Clin Oncol.1999;17:3569–76.
4. Stone RM. The difficult problem of acute myeloid leukemia in older adult. CA Cancer J Clin. 2002;52:363–71.
5. Appelbaum FR, Gundacker H, Head DR, Slovak, et al. Age and acute myeloid leukemia. Blood. 2006;107:3481–5.
6. Kantarjian H, O’Brien S, Cortes J, et al. Results of intensive chemotherapy in 998 patients age 65 years or older with acute myeloid leukemia or high risk myelodisplastic syndrome: predictive prognostic models for outcome. Cancer. 2006;106:1090-8.
7. Djunic I, Virijevic M, Novkovic A, et al. Comorbidity as a risk factor for overall survival and decision criteria for intensity of chemotherapy in elderly patients with acute myeloid leukemia. Med Oncol. 2012;29:1077–81.
8. Pulsoni A, Pagano L, Latagliata R, et al. Survival of elderly patients with acute myeloid leukemia. Haematologica. 2004;89:296-302.
9. Röllig C, Thiede C, Gramatzki M, et al. A novel prognostic model in elderly patients with acute myeloid leukemia: results of 909 patients entered into the prospective AML96 trial. Blood.2010;116(6):971-8.
10. Malfuson JV, Etienne A, Turlure P, et al. Risk factors and decision criteria for intensive chemotherapy in older patients with acute myeloid leukemia. Haematologica.2008;93:1806–13.
11. Erba HP. Prognostic factors in elderly patients with AML and the implications for treatment. Hematology Am Soc Hematol Educ Program.2007:420-8.
12. Wedding U, Höffken K. Therapy of acute myeloid leukemia in the elderly patient. Z Gerontol Geriatr.2001;34(4):269-76.
13. Oken MM, Creech RH, Tormey DC,et al. Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J ClinOncol1982;5:649-55.

14. Sorror ML, Storb RF, Sandmaier BM, et al. Comorbidity-age index: a clinical measure of biologic age before allogeneic hematopoietic cell transplantation. J ClinOncol 2014; 32: 3249- 56.

15. Döhner H, Estey EH, Amadori S, et al..Diagnosis and management of acute myeloid leukemia in adults: recommendations from an international expert panel, on behalf of the European Leukemia Net. Blood2010;115:453-74.

16. Arber DA, Brunning RD, Le Beau, et al. MM WHO classification. IARC. Lyon, 2008;p.110-146.

17. Bene MC, Nebe T, Bettelheim P, et al. Immunophenotyping of acute leukemia and lymphoproliferative disorders: a consensus proposal of the European LeukemiaNet Work Package 10. Leukemia.2011;25(4):567-74.

18. International System for Human Cytogenetic Nomenclature (ISCN). Recomendations for the International Standing Commitee on Human Cytogenetic Nomenclature. Memphis, Thenessy, USA,1994.

19. Cheson BD, Bennet JM, Kopecky KJ, et al. International Working Group for diagnosis, standardization of response criteria, treatment outcomes, and reporting standards for therapeutic trials in acute myeloid leukemia. Revised recommendations of the international working group for diagnosis, standardization of response criteria, treatment outcome, and reporting standards for therapeutic trials in acute myeloid leukemia. J ClinOncol2003;21:4642–9.

20. Walter RB, Othus M, Borthakur G, et al. Prediction of early death after induction therapy for newly diagnosed acute myeloid leukemia with pretreatment risk scores: a novel paradigm for treatment assignment. J ClinOncol. 2011; 29(33):4417-23.
21. Breccia M, Frustaci AM, Cannella L, et al. Comorbidities and FLT3-ITD abnormalities as independent prognostic indicators of survival in elderly acute myeloid leukemia patients. Haem Oncol.2009;27:148–53.
22. Fröhling S, Schlenk RF, Kayser S, et al. for the German-Austrian AML StudyGroup. Cytogenetics and age are major determinants of outcome in intensively treated acute myeloid leukemia patients older than 60 years: results from AMLSG trial AML HD98-B. Blood.2006;108:3280-8.
23. AppelbaumFR,GundackerH,HeadDR.,etal.Age and acute myeloid leukemia. Blood. 2006;107:3481-5.
24. Menzin J, Lang K, Earle CC, Kerney D, Mallick R., The outcomes and costs of acute myeloid leukemia among the elderly. Arch Intern Med.2002;162:1597-1603.
25. Etienne A, Esterni B, Charbonnier A, et al. Comorbidity is an independent predictor of complete remission in elderly patients receiving induction chemotherapy for acute myeloid leukemia. Cancer.2007;109:1376–83.
26. Giles FJ, Borthakur G, Ravandi F, et al. The haematopoetic cell transplantation comorbidity index score predictive of early death and survival in patients over 60 years of age receiving induction therapy for acute myeloid leukemia. Br J Haematol.2007;136:624–7.