Τίτλος:
Estimated glomerular filtration rate independently predicts outcome of azacitidine therapy in higher-risk Myelodysplastic syndromes. Results from 536 patients of the Hellenic National Registry of Myelodysplastic and Hypoplastic syndromes
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
Higher-risk Myelodysplastic syndromes (MDS) patients undergoing treatment with 5-azacytidine (AZA) are typically elderly with several comorbidities. However, the effect of comorbidities on the effectiveness and safety of AZA in real-world settings remains unclear. We analyzed data from 536 AZA-treated patients with higher-risk MDS, Myelodysplastic/Myeloproliferative neoplasms and low blast count Acute Myeloid Leukemia enrolled to the Hellenic National Registry of Myelodysplastic and Hypoplastic Syndromes. Multivariate analysis adjusted also for the International Prognostic Scoring System (IPSS), its revised version (IPSS-R) and the French Prognostic Scoring System (FPSS), demonstrated independent associations of overall and leukemia-free survival with estimated glomerular filtration rate (eGFR) <45 mL min−1/1.73 m2 (P =.039, P =.023, respectively), ECOG performance status <2 (P =.015, P =.006), and presence of peripheral blood blasts (P =.008, P =.034), while secondary MDS also correlated with significantly shorter leukemia-free survival (P =.039). Addition of eGFR <45 mL min−1/1.73 m2, in IPSS-R and FPSS increased the predictive power of both models. Only FPSS ≤2 and eGFR <45 mL min−1/1.73 m2 predicted worse response to AZA in multivariate analysis, whereas eGFR <45 mL min−1/1.73 m2 correlated significantly with death from hemorrhage (P =.003) and cardiovascular complications (P =.006). In conclusion, in the second largest real-world series of AZA-treated MDS patients, we show that an eGFR <45 mL min−1/1.73 m2 is an independent predictor of worse response and survival. This higher cut-off, instead of the commonly used serum creatinine >2 mg/dL, can be utilized as a more precise indicator of renal comorbidity during AZA therapy. Incorporation of eGFR in the prognostic assessment of AZA-treated MDS patients may prove useful not only in routine practice, but also for the appropriate patient stratification in clinical trials with AZA combinations. © 2020 John Wiley & Sons Ltd
Συγγραφείς:
Papadopoulos, V.
Diamantopoulos, P.T.
Papageorgiou, S.G.
Papoutselis, M.
Vrachiolias, G.
Pappa, V.
Galanopoulos, A.G.
Vassilakopoulos, T.P.
Hatzimichael, E.
Zikos, P.
Papadaki, H.A.
Bouchla, A.
Panayiotidis, P.
Megalakaki, A.
Papaioannou, M.
Liapis, K.
Dryllis, G.
Tsokanas, D.
Kourakli, A.
Symeonidis, A.
Viniou, N.-A.
Kotsianidis, I.
Περιοδικό:
Journal of Hematology & Oncology
Εκδότης:
John Wiley and Sons Ltd
Λέξεις-κλειδιά:
azacitidine; erythropoietin; antineoplastic antimetabolite; azacitidine, acute myeloid leukemia; adult; aged; Article; cancer classification; cancer prognosis; cancer specific survival; cancer therapy; cardiovascular disease; clinical decision making; cohort analysis; comparative study; controlled study; correlational study; estimated glomerular filtration rate; female; gastrointestinal toxicity; high risk patient; human; International Prognostic Scoring System; kidney function; liver disease; lung tumor; major clinical study; male; myelodysplastic syndrome; outcome assessment; overall response rate; priority journal; follow up; glomerulus filtration rate; kidney disease; middle aged; mortality; myelodysplastic syndrome; pathology; prognosis; register; survival rate; very elderly, Adult; Aged; Aged, 80 and over; Antimetabolites, Antineoplastic; Azacitidine; Female; Follow-Up Studies; Glomerular Filtration Rate; Humans; Kidney Diseases; Male; Middle Aged; Myelodysplastic Syndromes; Prognosis; Registries; Survival Rate
