Denutrition status prevails over a standard AML risk assessment in older adults

IF 3.2 4区医学 Q2 MEDICINE, RESEARCH & EXPERIMENTAL

Current Research in Translational Medicine Pub Date : 2025-02-06 DOI:10.1016/j.retram.2025.103500

Laura Simon , Alexis Caulier , Céline Berthon , Thomas Boyer , Véronique Harrivel , Magalie Joris , Isabelle Leduc , Nicolas Duployez , Claude Preudhomme , Jean-Pierre Marolleau , Delphine Lebon

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Abstract

Older adults with acute myeloid leukemia (AML) have a poor prognosis because frailty and the characteristics of the disease limit the use of intensive chemotherapy (ICT). Treatment with 5-azacitidine (5-AZA) or low-dose cytarabine (Cytarabine) (LDAC) – with or without venetoclax – is currently recommended in this setting. However, we lack real-life data on response rates and treatment outcomes.

We conducted a retrospective, multicenter registry study of 279 older adults with AML (median [interquartile range (IQR)] age: 76 [70–81]) having undergone first-line treatment with LDAC (n = 87) or 5-AZA (n = 192) between 2009 and 2019 (i.e. mainly before the venetoclax era) in a university medical center in France. The complete remission rate was 27.3 % overall. After a median follow-up period of 6.9 months, the median [IQR] overall survival (OS) time was shorter in the LDAC group (4.8 months [2.13–14.41]) than in the 5-AZA group (8.9 months [3.2–13.5]; p = 0.046). Ultimately, however, the OS rates were similar in the LDAC and 5-AZA groups (hazard ratio [HR]: 95 % confidence interval [CI]: 1.37 [0.92–2.04], p = 0.12).

None of the conventional markers with prognostic value in younger patients receiving ICT (such as those in the European LeukemiaNet classification) appeared to predict the outcome in our population of older patients. Albumin <30 g/L was the only factor that predicted day-30 mortality and OS (adjusted odds ratio [95 %CI]: 6.25 [2.08 – 20.0]; p < 0.001; adjusted HR [95 %CI]: 0.65 [0.44–0.96]; p = 0.030).

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在老年人中，营养不良状况比标准AML风险评估更重要

老年人急性髓性白血病（AML）预后较差，因为虚弱和疾病的特点限制了强化化疗（ICT）的使用。在这种情况下，目前推荐使用5-阿扎胞苷（5-AZA）或低剂量阿糖胞苷（阿糖胞苷）（LDAC）联合或不联合venetoclax治疗。然而，我们缺乏关于反应率和治疗结果的真实数据。我们对2009年至2019年（即主要在venetoclax时代之前）在法国一所大学医学中心接受LDAC （n = 87）或5-AZA （n = 192）一线治疗的279名老年AML患者（中位[四分位数范围（IQR）]年龄：76[70-81]）进行了一项回顾性、多中心注册研究。总体完全缓解率为27.3%。中位随访期为6.9个月后，LDAC组的中位总生存期（IQR）（4.8个月[2.13-14.41]）短于5-AZA组（8.9个月[3.2-13.5]）；P = 0.046)。然而，最终，LDAC组和5-AZA组的OS率相似（风险比[HR]: 95%可信区间[CI]: 1.37 [0.92-2.04], p = 0.12）。在接受ICT治疗的年轻患者中，没有一种具有预后价值的传统标志物（如欧洲白血病网分类）能够预测老年患者的预后。白蛋白30 g/L是预测第30天死亡率和总生存率的唯一因素(校正比值比[95% CI]: 6.25 [2.08 - 20.0]；p & lt;0.001;校正后HR [95% CI]: 0.65 [0.44-0.96]；P = 0.030)。

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来源期刊

Current Research in Translational Medicine Biochemistry, Genetics and Molecular Biology-General Biochemistry,Genetics and Molecular Biology

CiteScore

7.00

自引率

4.90%

发文量

审稿时长

45 days

期刊介绍： Current Research in Translational Medicine is a peer-reviewed journal, publishing worldwide clinical and basic research in the field of hematology, immunology, infectiology, hematopoietic cell transplantation, and cellular and gene therapy. The journal considers for publication English-language editorials, original articles, reviews, and short reports including case-reports. Contributions are intended to draw attention to experimental medicine and translational research. Current Research in Translational Medicine periodically publishes thematic issues and is indexed in all major international databases (2017 Impact Factor is 1.9). Core areas covered in Current Research in Translational Medicine are: Hematology, Immunology, Infectiology, Hematopoietic, Cell Transplantation, Cellular and Gene Therapy.