| Objective:We retrospectively analyzed the curative effect and prognosis of different treatment regimens for elderly patients who were first diagnosed acute myeloid leukemia,and assessed the influencing factors of curative effect and prognosis.Method:Clinical data were collected from patients who were first diagnosed the AML(except APL)in the Second Affiliated Hospital of Nanchang University from August2015 to December 2021.All the patients were aged ≥60 years.MICM typing was performed for all patients based on cytomorphology,immunology,cytogenetics,and molecular biology.The patients were divided into standard treatment group and demethylation group according to treatment plan,and the demethylation group was divided into decitabine(DEC)group vs azacidine(AZA)group,venetoclax group vs non-venetoclax group.The curative effect,prognosis and adverse events among each group were observed.The statistical analysis was performed with SPSS 25.0software.Results:(1)Clinical characteristics:1)Clinical data:A total of 101 cases were collected in this study,including 56 males and 45 females.The median age of them is 66.00(63.00,69.50)years.There were 93 cases of primary AML and 8 cases of secondary AML in them.There were 2 cases of M0,12 cases of M1,54 cases of M2,12 cases of M5,1 case of M6 and 1 case of M7 in MICM classification.Prognostic risk stratification included low risk 8 cases,medium risk 53 cases and high risk 40 cases.The PS score was 0-1 in 80 patients,2-3 in 21patients;CCI scores were 0-1 in 90 patients and 2-3 in 15 patients.2)Molecular genetic data:Chromosome test results of 101 patients: Chromosome karyotype of t(8;21)(q22;q22.1)were 7 cases,inv(16)(p13q22)were 1 case;There were 2 cases of adverse chromosome karyotype of-7,15 cases of complex chromosome karyotype,11 cases of other chromosome karyotypes and 65 cases of normal chromosome karyotype.Genetic test results of 80 patients: There were 13 cases of FLT3-ITD gene mutations,10 cases of NPM1 gene mutations,10 cases of IDH gene mutations,10 cases of DNMT3 A gene mutations,13 cases of TET2 gene mutations,14 cases of RUNX1 gene mutations,9 cases of ASXL1 gene mutations and 5 cases of TP53 gene mutations.There were 6 cases of Eto gene mutations(5 with favorable chromosome karyotype),8 cases of CEBPA gene double mutations(1 with favorable chromosome karyotype)and 5 single mutations,4 cases of RAD21 gene mutations,3 cases of KIT gene mutations(without t(8;21)(q22;q22.1)chromosome karyotype),all of which were multi-gene mutations.(2)Curative effect and prognosisl analysis:1)After the first course of induction chemotherapy,all the patients’ CR rate was51.49%,ORR was 67.33% and median OS was 14.0 months.Among the patients with low risk,medium risk and high risk,the CR rates were 62.50%,52.83%,and 47.50%,ORR were 75.00%,67.92%,and 65.00%,median OS was 29.0,16.0,and 12.3months.Early death occurred in seven patients.2)In standard treatment group,After the first course of induction chemotherapy,the CR rate was 43.18%,ORR was 56.82%,median OS was 10.1 months,and 5patients died early.Among the patients with low risk,medium risk and high risk,the CR rates were 50.00%,44.44%,and 40.00%,ORR were 50.00%,59.26%,and53.33%,median OS were 10.5,18.5,and 12.3 months.In the demethylation group,after the first course of induction chemotherapy,the CR rate,ORR and median OS were 57.89%,75.44% and 14.0 months,and 2 patients died early.Among the patients with low risk,medium risk and high risk,the CR rates were 66.67%,61.54%,and 52.00%,ORR were 83.33%,76.92%,and 72.00%,median OS were 29.0,10.2,and 9.9 months.The ORR of the demethylation group was better than that of the standard treatment group.3)In DEC group,after the first course of induction chemotherapy,CR rate was48.39%,ORR was 67.74%,median OS was 11.4 months,and 1 patient died early.Among the patients with low risk,medium risk and high risk,CR rates were50.00%,52.94%,and 40.00%,ORR were 75.00%,64.71%,and 70.00%,median OS was 10.5,16.0,and 9.0 months.In AZA group,after the first course of induction chemotherapy,CR rate was 69.23%,ORR was 84.62%,median OS was 14.0 months,and 1 patient died early.Among the patients with low risk,medium risk and high risk,CR rates were 100.00%,77.78%,and 60.00%,ORR was 100.00%,100.00%,and73.33%,median OS was 3.0,22.7,and 12.3 months.There was no statistical difference between the two groups.4)In venetoclax group,after the first course of induction chemotherapy,the CR rate was 86.67%,ORR was 93.33%,median OS was not reached,and 0 patients died early.Among the patients with low risk,medium risk and high risk,CR rates were100.00%,100.00%,and 71.43%,ORR were 100.00%,100.00%,and 85.71%,the median OS was not reached.In the non-venetoclax group,after the first course of induction chemotherapy,CR rate was 47.62%,ORR was 69.05%,median OS was12.3 months,and 2 patients died early.Among the patients with low risk,medium risk and high risk,CR rates were 60.00%,47.37%,and 44.44%,ORR were 80.00%,68.42%,and 66.67%,median OS were 10.5,16.0,and 12.3 months.The CR rate of patients in the venetoclax group was better than that in the non-venetoclax group,and the difference in CR rate between the two different treatment regimens was statistically significant in medium-risk patients,while there was no other statistical difference between the two groups.5)Influencing factors:Univariate analysis showed that CCI score ≥2,platelet count < 20×109/L,LDH≥300IU/L,and treatment 3(standard treatment group,venetoclax group and non-venetoclax group)were associated with CR rate.Peripheral blood primitive cells≥50%,treatment 1(standard treatment group and demethylation treatment group),treatment 3(standard treatment group,venetoclax group and non-venetoclax group)were associated with ORR.RUNX1 gene mutation is associated with patients’ OS.Multivariate analysis showed that PLT count < 20×109/L was an independent risk factor for CR rate in elderly AML patients.Peripheral blood primitive cells≥50% were independent risk factors for ORR in elderly AML patients.RUNX1 gene mutation is an independent risk factor for OS in elderly AML patients.(3)Adverse events: The main hematological adverse event of all patients was 3/4bone marrow suppression,and the main non-hematological adverse events were infection,neutropenic fever and gastrointestinal discomfort.Pulmonary infection was the most common infection.The incidence of neutropenic fever and gastrointestinal adverse reactions was higher in the standard treatment group.Conclusion:1).Elderly AML patients have low overall remission rate and short survival.2).Elderly AML patients have a high proportion of adverse cytogenetics and gene mutations.3).For elderly AML patients at initial diagnosis,peripheral blood PLT <20×109/L was an important independent adverse factor affecting CR rate,peripheral blood primitive cells ≥50% was an important independent adverse factor affecting ORR,and RUNX1 gene mutation was an independent adverse prognostic factor affecting OS.4).New targeted drugs are expected to improve the curative effect of AML in elderly patients. |
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