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.

Autor: Papadopoulos V; Department of Hematology, Democritus University of Thrace Medical School, Alexandroupolis, Greece., Diamantopoulos PT; First Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece., Papageorgiou SG; Second Department of Internal Medicine, Hematology Unit, Attikon University General Hospital, Athens, Greece., Papoutselis M; Department of Hematology, Democritus University of Thrace Medical School, Alexandroupolis, Greece., Vrachiolias G; Department of Hematology, Democritus University of Thrace Medical School, Alexandroupolis, Greece., Pappa V; Second Department of Internal Medicine, Hematology Unit, Attikon University General Hospital, Athens, Greece., Galanopoulos AG; Department of Clinical Hematology, G. Gennimatas Hospital, Athens, Greece., Vassilakopoulos TP; Department of Hematology, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece., Hatzimichael E; Department of Hematology, University Hospital of Ioannina, Ioannina, Greece., Zikos P; Department of Hematology, General Hospital of Patras 'Agios Andreas', Patras, Greece., Papadaki HA; Department of Hematology, University General Hospital of Heraklion, Heraklion, Greece., Bouchla A; Second Department of Internal Medicine, Hematology Unit, Attikon University General Hospital, Athens, Greece., Panayiotidis P; First Propaedeutic Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece., Megalakaki A; Department of Hematology, 'Metaxa' Piraeus Cancer Hospital, Piraeus, Greece., Papaioannou M; Department of Hematology, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece., Liapis K; Department of Hematology, Democritus University of Thrace Medical School, Alexandroupolis, Greece., Dryllis G; First Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece., Tsokanas D; Department of Internal Medicine, University Hospital of Patras, Rio, Greece., Kourakli A; Department of Internal Medicine, University Hospital of Patras, Rio, Greece., Symeonidis A; Department of Internal Medicine, University Hospital of Patras, Rio, Greece., Viniou NA; First Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece., Kotsianidis I; Department of Hematology, Democritus University of Thrace Medical School, Alexandroupolis, Greece.
Jazyk: angličtina
Zdroj: Hematological oncology [Hematol Oncol] 2020 Oct; Vol. 38 (4), pp. 541-553. Date of Electronic Publication: 2020 Jun 26.
DOI: 10.1002/hon.2756
Abstrakt: 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 m 2 (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 m 2 , in IPSS-R and FPSS increased the predictive power of both models. Only FPSS ≤2 and eGFR <45 mL min -1 /1.73 m 2 predicted worse response to AZA in multivariate analysis, whereas eGFR <45 mL min -1 /1.73 m 2 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 m 2 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.)
Databáze: MEDLINE
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