老年中高危骨髓增生异常综合征患者的临床特点及预后研究

Clinical Characteristics and Prognosis of Elderly Patients with Medium and High risk Myelodysplastic Syndrome

目的:探讨老年中高危骨髓增生异常综合征(MDS)患者的临床特点及预后。方法:回顾性分析2011年2月至2020年8月在南方医科大学南方医院就诊的97例年龄≥60岁、IPSS-R危险分层为中危/高危/极高危MDS患者的临床特点及预后情况。根据采取治疗方案的不同,将患者分为移植、化疗和其他治疗3组,分析评估不同治疗组患者之间疗效的差别。结果:老年中高危MDS患者以MDS伴原始细胞增多型(MDS-EB)为主,47.4%的患者合并染色体核型异常,其中复杂核型(≥3个)占23.7%。97.3%的患者至少存在一种基因突变,TP53突变在老年中高危MDS患者中检出率近20%。多因素分析显示,IPSS-R危险分层、治疗方案影响老年中高危MDS患者的预后。3组患者的中位生存(OS)时间统计学差异(P=0.012),移植组中位OS长于化疗组及其他治疗组(P=0.003、P=0.014),化疗组和其他治疗组的中位OS无统计学差异(P=0.685)。结论:老年中高危MDS患者可从异基因造血干细胞移植中获益,OS延长。

Objective:To investigate the clinical characteristics and prognosis of patients with medium and high risk myelodysplastic syndrome(MDS).Methods:97 M DS patients above the age of 60 treated in Nanfang Hospital,Southern Medical University from February 2011 to August 2020 were enrolled.The clinical characteristics and prognosis of the MDS patients with medium risk,high risk or very high risk based on IPSS-R category were retrospectively analyzed.According to the difference of treatment regimes,the patients were divided into the transplantation group,chemotherapy group and other treatment group,and the efficacy among the patients in the 3 groups were analyzed.Results:MDS with excess blast(MDS-EB) in the elderly patients with medium and high risk MDS were the most common,47.4% of the patients with abnormal chromosome karyotypes,and 23.1% with complex karyotypes(≥3).97.3% of the patients showed at least one gene mutation,and TP53 mutations were detected in nearly 20% of the patients with medium and high risk.Multivariate analysis showed that IPSS-R category and treatment regimes were the factors affecting the prognosis of elderly patients with medium and high risk MDS.The median overall survival(OS)time of the patients in the 3 groups showed significant difference(P=0.012),and the median OS of the patients in the transplantation group was significantly longer than that in the chemotherapy group and other group(P=0.003,P=0.014,respectively),while there was no significant difference in median OS between chemotherapy group and other treatment group(P=0.685).Conclusion:Elderly MDS patients with medium and high risk can benefit from allogeneic hematopoietic stem cell transplantation,which will prolong their OS.