Objective: To analyze the clinical features of acute myeloid leukemia (AML)/high-risk myelodysplastic syndrome (MDS) patients aged over 60 years old.
Methods: The clinical data of 61 elderly newly diagnosed patients with AML and high-risk MDS who submitted to the Department of Hematology/Oncology of the First Affiliated Hospital of Tsinghua University from January 2009 to April 16, 2021 were retrospectively analyzed. These patients were divided into chemotherapy group (45 cases) and supportive treatment group (16 cases). The overall survival (OS) was analyzed by Kaplan-Meier method, and the prognostic factors of survival were analyzed by multivariate Cox regression.
Results: After 2 cycles of induction chemotherapy, the complete remission (CR) rate was 37.8% (17/45), and overall response rate was 62.2% (28/45) in the chemotherapy group. The median OS in the chemotherapy group and supportive treatment group was 11.3 (0.07-43) and 1.6 (0.33-7.72) months, respectively (P<0.001). The median OS in patients who reached CR or did not reach after 1 cycle of induction chemotherapy was 19.8 (10-30.63) and 8.17 (0.07-43) months, respectively (P<0.05), while after 2 cycles was 22.7 (4.2-43) and 7.26 (0.07-26) months, respectively (P<0.001). Univariate analysis showed that age > 80 years old, CCI score > 2, PS score > 2 and supportive treatment were the adverse prognostic factors for OS. Further multivariate analysis suggested that chemotherapy was the only independent prognostic factor for OS (HR=0.140, 95%CI: 0.048-0.409, P<0.001). In the chemotherapy group, univariate analysis showed that CCI score > 2 and failure to reach CR after induction chemotherapy were poor prognostic factors. Multivariate analysis showed that CCI score > 2 (HR=0.139, 95%CI: 0.050-0.384, P<0.001) and failure to achieve CR after induction chemotherapy (HR=0.103, 95%CI: 0.041-0.259, P<0.001) were the adverse prognostic factors for OS. The patients were tolerant to side-effect of chemotherapy.
Conclusion: Appropriate chemotherapy can prolong the survival of elderly patients with AML and high-risk MDS.
题目: 老年AML和高危MDS患者的临床分析.
目的: 对60岁以上老年急性髓系白血病（AML）和高危骨髓增生异常综合征（MDS）患者进行临床分析。.
方法: 回顾性分析清华大学第一附属医院血液肿瘤科2009年1月至2021年4月16日就诊的61例老年AML/高危MDS患者的临床资料，接受化疗组45例，单纯支持治疗组16例，应用Kaplan-Meier方法对患者进行单因素生存分析，多因素Cox回归进行生存预后因素分析。.
结果: 化疗组诱导化疗2个疗程后完全缓解（CR）率为37.8%（17/45），总有效率为62.2%（28/45）。化疗和支持治疗组的中位生存时间（OS）分别为11.3（0.07-43）和1.6（0.33-7.72）个月（P<0.001）。化疗组中第一疗程达CR的患者与未达CR的患者中位OS分别是19.8（10-30.63）和8.17（0.07-43）个月（P<0.05）；经过2个疗程达CR的患者与未达CR的患者中位OS分别是22.7（4.2-43）和7.26（0.07-26）月（P<0.001）。单因素分析结果显示，年龄>80岁、CCI评分>2分、PS评分>2分、支持治疗4项指标是影响患者生存期的不良预后因素；多因素分析结果显示，化疗是影响生存期的唯一独立预后因素（HR=0.140，95%CI：0.048-0.409，P<0.001）。化疗组单因素分析结果提示，CCI评分>2分、诱导化疗未达CR为不良预后因素；多因素分析结果显示，CCI评分>2分（HR=0.139，95%CI：0.050-0.384，P<0.001）、诱导化疗未达CR（HR=0.103，95%CI：0.041-0.259，P<0.001）为影响生存期的不良预后因素。患者对化疗耐受性尚可。.
结论: 对老年AML和高危MDS患者采取适宜的化疗方案能够延长其生存期。.
Keywords: acute myeloid leukemia; chemotherapy; elderly patient; myelodysplastic syndrome; supportive treatmen.