打破虚弱：评估急性髓系白血病的脆弱性。
Breaking down frailty: Assessing vulnerability in acute myeloid leukemia.
发表日期：2024 Jul 18
作者：
Lacey S Williams, Teja Nagaradona, Prathik Nalamalapu, Catherine Lai
来源：
BLOOD REVIEWS
摘要：
急性髓系白血病（AML）是一种主要影响老年人的疾病。然而，并非所有老年患者都适合接受强化化疗的根治性治疗，因为他们的功能状态、生理储备以及对疾病和治疗发病的脆弱性表现出“虚弱”。对于如何选择最适合标准强化化疗 (IC)、低甲基化药物 (HMA) 与维奈托克或强度较低的治疗方案的老年、体质较差的患者，尚未达成共识。总共 37 项关于 AML 衰弱评估和综合指数的研究显示，关于衰弱和综合老年评估 (CGA) 措施预测治疗结果的能力，结果存在异质性。 CGA、老年 8 (G8) 风险评分和造血细胞移植合并症指数 (HCT-CI) 显示与预后相关，应在更大规模的治疗试验中进行验证。对白蛋白和 C 反应蛋白等生物标志物以及患者报告结果的研究表明，有可能增强从严格的老年评估中获得的信息。版权所有 © 2024。由 Elsevier Ltd 出版。
Acute myeloid leukemia (AML) is a disease primarily affecting older adults. However, not all patients at older ages are suitable for curative treatment with intensive chemotherapy due to "frailty" demonstrated by their functional status, physiologic reserve, and vulnerability to disease and treatment morbidity. Lack of consensus exists on how to select older, less fit patients most appropriate for standard intensive chemotherapy (IC), hypomethylating agents (HMA) with venetoclax, or less intensive regimens. A total of 37 studies of frailty assessments and composite indices in AML show heterogeneous results regarding the ability of frailty and Comprehensive Geriatric Assessment (CGA) measures to predict treatment outcomes. CGA, Geriatric 8 (G8) risk score, and hematopoietic cell transplant comorbidity index (HCT-CI) show association with prognosis, and should be validated in larger therapeutic trials. Studies of biomarkers, like albumin and C-reactive protein, and patient-reported outcomes demonstrate the potential to enhance information gained from rigorous geriatric assessment.Copyright © 2024. Published by Elsevier Ltd.