老年人骨髓增生异常综合征继发性急性髓系白血病的特征和生存率：一项人群分析。

IF 2.7 4区医学 Q2 HEMATOLOGY

Clinical Lymphoma, Myeloma & Leukemia Pub Date : 2025-01-23 DOI:10.1016/j.clml.2025.01.012

Akshee Batra , Andrew Sparks , Rohit Singh , Neil A. Zakai , Diego Adrianzen Herrera

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引用次数: 0

摘要

背景：由骨髓增生异常综合征（MDS）引起的急性髓性白血病（AML）是继发性AML （sAML）中一种独特的亚型，预后较差。我们确定了其在老年人中的流行病学概况。方法：使用SEER-Medicare数据库，我们确定了2007年至2017年间发展为AML的MDS病例，这是在低甲基化药物（HMA）时代。已建立的算法通过简化骨髓增生异常综合征风险评分（SMMRS）确定人口统计学、MDS组织学、MDS风险、合并症、输血负担和HMA治疗。我们定义了sAML后的总生存期（OS），并检查了与AML和死亡率相关的因素，包括先前HMA治疗的影响。结果：15227名MDS患者中，12.3%发展为AML。发病率因MDS的组织学和SMMRS而异。SMMRS越高，AML时间越短。老年和较高的合并症与较低的AML发病率相关。较高的SMMRS （OR = 2.5, 95CI: 2.0-3.0）、输血依赖（OR = 2.6, 95CI: 2.1-3.2）和HMA使用（OR = 4.9, 95CI: 4.4-5.5）与转化风险增加相关。AML诊断后的中位OS为3个月。1年和2年的总生存率分别为25%和12%。存活时间因先前MDS的组织学而异，环状铁母细胞的存活时间最长（P < 0.001）。年龄较大（HR = 1.4, 95CI: 1.1-1.9）和较高的SMMRS （HR = 1.8, 95CI: 1.5-2.2）与死亡风险相关。先前的HMA暴露与更长的生存期相关（4个月vs 2个月，P < 0.01）， 4个或更多的HMA周期与死亡风险降低相关（HR = 0.53, 95CI: 0.47-0.60）。结论：即使在低风险MDS组织中，sAML的风险也是显著的。生存率较差，且因MDS的既往特征而异。HMA暴露与更长的生存期的关系值得进一步分析。

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Characteristics and Survival of Secondary Acute Myeloid Leukemia From Myelodysplastic Syndromes in Older Adults: A Population Analysis

Background

Acute myeloid leukemia (AML) arising from myelodysplastic syndromes (MDS) is a unique subtype of secondary AML (sAML) with poor prognosis. We defined its epidemiologic profile in older adults.

Methods

Using the SEER-Medicare database, we identified MDS cases that progressed to AML between 2007 and 2017, during the era of hypomethylating agents (HMA). Established algorithms determined demographics, MDS histology, MDS risk by Simplified Myelodysplastic Syndrome Risk Score (SMMRS), comorbidity, transfusion burden, and HMA therapy. We defined overall survival (OS) after sAML, and examined factors associated with AML and mortality, including the impact of prior HMA therapy.

Results

Of 15,227 MDS patients, 12.3% developed AML. Incidence varied by MDS histology and SMMRS. Time to AML was shorter with higher SMMRS. Older age and higher comorbidity were associated with lower odds of AML. Higher SMMRS (OR = 2.5, 95CI: 2.0-3.0), transfusion dependence (OR = 2.6, 95CI: 2.1-3.2), and HMA use (OR = 4.9, 95CI: 4.4-5.5) were associated with increased transformation risk. Median OS after AML diagnosis was 3 months. OS rates at 1 and 2 years were 25% and 12%. Survival varied by antecedent MDS histology, being longest in those with ringed sideroblasts (P < .001). Older age (HR = 1.4, 95CI: 1.1-1.9) and higher SMMRS (HR = 1.8, 95CI: 1.5-2.2) were associated with risk of death. Antecedent HMA exposure was associated with longer OS (4 vs. 2 months, P < .01), with 4 or more HMA cycles associated with decreased risk of death (HR = 0.53, 95CI: 0.47-0.60).

Conclusion

Risk of sAML is significant even in lower-risk MDS histologies. Survival is poor and varies by antecedent MDS characteristics. HMA exposure association with longer survival warrants further analysis.

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来源期刊

Clinical Lymphoma, Myeloma & Leukemia ONCOLOGY-HEMATOLOGY

CiteScore

2.70

自引率

3.70%

发文量

1606

审稿时长

26 days

期刊介绍： Clinical Lymphoma, Myeloma & Leukemia is a peer-reviewed monthly journal that publishes original articles describing various aspects of clinical and translational research of lymphoma, myeloma and leukemia. Clinical Lymphoma, Myeloma & Leukemia is devoted to articles on detection, diagnosis, prevention, and treatment of lymphoma, myeloma, leukemia and related disorders including macroglobulinemia, amyloidosis, and plasma-cell dyscrasias. The main emphasis is on recent scientific developments in all areas related to lymphoma, myeloma and leukemia. Specific areas of interest include clinical research and mechanistic approaches; drug sensitivity and resistance; gene and antisense therapy; pathology, markers, and prognostic indicators; chemoprevention strategies; multimodality therapy; and integration of various approaches.