Efficacy and safety of azacitidine in the treatment of elderly patients with higher-risk myelodysplastic syndromes.
Notice bibliographique
Résumé
e18578 Background: Hypomethylating agent Azacitidine (AZA) is standard of care for high-risk myelodysplastic syndromes (MDS). There is limited real-life data, however, characterizing the efficacy and safety profile of AZA in elderly patients. Methods: A retrospective chart review of high-risk MDS patients at our institution who received front-line AZA therapy. Patients who proceeded with stem cell transplant were excluded. Patients were stratified by age: ≥75 years (elderly) vs <75 years (younger) and patterns of administration, safety, and efficacy of AZA in patients were compared. Results: Among a total of 105 patients, 56 were elderly (median age 79), including 27 patients >80 years, 49 were younger (median age 69). ECOG 3 had 8.9% of older & 12.2% of younger patients. Median R-IPSS score was 6.5 in younger vs 5.8 in elderly groups. Median number of comorbidities was 5 vs 6 in younger and elderly groups. 98% of elderly and 90% of younger patients received the full dose of AZA (75mg/m2). Median number of AZA cycles was 8 [range 1-107] in elderly vs 6 [1-96] in younger cohorts. Treatment delays had 35.7% of elderly vs 30.6% of younger patients, most commonly due to infection complications. Neutropenia, thrombocytopenia and anemia rates were 29.3%, 29.2%, and 26.8% in younger vs 43.6%, 25.2%, and 34.5% in older patients. Overall response rate was 92.8% in younger and 96.4% of elder patients, including complete remission in 53.7% and 58.3%, respectively. Relapse disease occurred in 48.8% of younger and 40.0% of elder patients. Transformation to AML was found in 9.8% of younger and 19.2% of elderly patients. Median OS was 17.3 months in the younger subgroup vs 15.7 in the elder group and 11.9 months in patients over 80 years. Rates of death were: 53.1% in younger vs 46.4% in the elderly. Causes of death were similar, including disease progression, sepsis, febrile neutropenia, pneumonia. Conclusions: AZA monotherapy is well-tolerated and effective in higher-risk MDS, even in very elderly patients (>80 years). Compared to clinical trial, patients in the real-world setting have shorter survival, higher ECOG status, and more comorbidities, potentially contributing to inferior outcomes. Clinical and hematological responses. Efficacy parameter/Age cohort, years (N) <75 (49) ≥75 (56) p value Hematological Response (median [min-max]) Baseline Hemoglobin (g/L) 77 [46-100] 80 [56-140] 0.014 Best Hemoglobin achieved on AZA (g/L) 103 [74-152] 108 [70-155] NS Baseline ANC (x10 9 /L) 0.7 [0-27] 0.89 [0.02-58] NS Best ANC achieved on AZA (x10 9 /L) 1.4 [0.02-12.3] 2.2 [0.04-9.6] 0.047 Baseline platelet count (x10 9 /L) 49 [2-600] 57 [16-558] 0.029 Best achieved on AZA (x10 9 /L) 128 [21-474] 155 [10-767] NS Transformation to AML N, (%) 4 (9.8) 10 (18.2) NS Reached transfusion independence, N (%) 30 (61.0) 38 (67.2) NS Response rate, N (%) ORR 46 (92.8) 54 (96.4) NS Complete Response 26 (53.7) 33 (58.2) NS Partial Response 11 (22.0) 11 (20.0) NS Stable Disease 8 (17.1) 10 (18.2) NS Mean Leukemia Free Survival (years) 1.13 1.05 NS Mean Overall Survival (years) 1.14 1.05 NS
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».