Complex karyotype is a marker of very poor prognosis in over 70-year-old patients with acute myeloid leukemia and extended types of myelodysplastic syndrome and high comorbidity index


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Aim. To identify a category of persons with very low overall survival (OS) rates, whose intensive chemotherapy is unreasonable, amongst the patients with acute myeloid leukemia (AML) with extended forms of myelodysplastic syndrome (MDS) and complex karyotype. Materials and methods. OS rates were retrospectively analyzed in 41 patients with AML and 26 with MDS; their median age was 61 years (range 15 to 77 years). Thirty-four (50.7%) patients received standard induction courses; 19 (28.4%) patients had low-intensity therapy. Restraining therapy was used to treat 14 (20.9%) patients. The length of follow-up was 1.5 to 171 months. Results. Irrespective of the type of disease, the median OS was 6 months. A difference in OS was found when the patients were divided into 4 age groups: those who were under 40 years of age (n=11), 41-60 years (n=21), 61-69 years (n=21), and ≥70 years (n=14). With age, the median OS decreased from 9.5 to 4 months (p=0.041). Multivariate analysis revealed that the intensity of induction courses was the cause that affected OS. High comorbidity index and, first of all, cardiovascular diseases were the main reason for discontinuing standard chemotherapy courses in patients aged 70 years or older. Conclusion. Standard induction courses of cytostatic therapy are not indicated for patients aged ≥70 years with AML and extended stages of MDS with complex karyotype and high comorbidity index.

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Комплексный кариотип - маркер крайне неблагоприятного прогноза у больных острыми миелоидными лейкозами с развернутыми вариантами миелодиспластического синдрома старше 70 лет с высоким индексом коморбидности. - Резюме. Цель исследования. Выделить среди больных острыми миелоидными лейкозами (ОМЛ) с развернутыми стадиями миелодиспластического синдрома (МДС) и комплексным кариотипом категорию лиц с крайне низкой общей выживаемостью (ОВ), у которых проведение интенсивной химиотерапии нецелесообразно. Материалы и методы. Проведен ретроспективный анализ ОВ 41 больного ОМЛ и 26 больных с МДС, медианой возраста 61 год (от 15 до 77 лет). Стандартные индукционные курсы получили 34 (50,7%) больных, терапию низкой интенсивности - 19 (28,4%). Для лечения 14 (20,9%) больных использована сдерживающая терапия. Длительность наблюдения за больными составила от 1,5 до 171 мес. Результаты. Медиана общей продолжительности жизни (ОПЖ) больных независимо от вида заболевания составила 6 мес. Различие по ОВ было выявлено при распределении больных в 4 возрастные группы: моложе 40 лет (n=11), 41-60 лет (n=21), 61-69 лет (n=21) и ≥70 лет (n=14). По мере увеличения возраста медиана ОПЖ снизилась с 9,5 до 4 мес (р=0,041). При многофакторном анализе выявлено, что причиной, которая влияет на ОВ, является интенсивность индукционных курсов. Основной причиной отказа от проведения стандартных курсов химиотерапии больным 70 лет и старше был высокий индекс коморбидности и, прежде всего, наличие заболеваний сердечно-сосудистой системы. Заключение. Больным ОМЛ с развернутыми стадиями МДС в возрасте ≥70 лет с комплексным кариотипом и высоким индексом коморбидности проведение стандартных индукционных курсов цитостатической терапии не показано.
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