Charlson comorbidity index and adult comorbidity evaluation-27 scores might predict treatment compliance and development of pleural effusions in elderly patients with chronic myeloid leukemia treated with second-line dasatinib

被引:52
作者
Breccia, Massimo [1 ]
Latagliata, Roberto [1 ]
Stagno, Fabio [2 ]
Luciano, Luigiana [3 ]
Gozzini, Antonella [4 ]
Castagnetti, Fausto [5 ]
Fava, Carmen [6 ]
Cavazzini, Francesco [7 ]
Annunziata, Mario [8 ]
Rossi, Antonella Russo [9 ]
Pregno, Patrizia [10 ]
Abruzzese, Elisabetta [11 ]
Vigneri, Paolo [2 ]
Rege-Cambrin, Giovanna [6 ]
Sica, Simona [12 ]
Pane, Fabrizio [3 ]
Santini, Valeria [4 ]
Specchia, Giorgina [9 ]
Rosti, Gianantonio [5 ]
Alimena, Giuliana [1 ]
机构
[1] Univ Roma La Sapienza, Dept Cellular Biotechnol & Hematol, I-00161 Rome, Italy
[2] Osped Ferrarotto, Catania, Italy
[3] Univ Naples Federico II, Naples, Italy
[4] Univ Florence, I-50121 Florence, Italy
[5] Univ Bologna, I-40126 Bologna, Italy
[6] Polo Univ ASO San Luigi Gonzaga, Orbassano, Italy
[7] Univ Ferrara, I-44100 Ferrara, Italy
[8] Osped Cardarelli, Naples, Italy
[9] Univ Bari, I-70121 Bari, Italy
[10] Osped San Giovanni Battista Torino, Turin, Italy
[11] Osped St Eugenio, Rome, Italy
[12] Univ Cattolica Sacro Cuore, Rome, Italy
来源
HAEMATOLOGICA-THE HEMATOLOGY JOURNAL | 2011年 / 96卷 / 10期
关键词
chronic myeloid leukemia; dasatinib; Charlson comorbidity index; adult comorbidity evaluation 27 (ACE-27); CHRONIC MYELOGENOUS LEUKEMIA; CHRONIC-PHASE; MANAGEMENT; EFFICACY;
D O I
10.3324/haematol.2011.041251
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background Comorbidities may affect survival and choice of treatment among cancer patients. In fact, comorbidities have been identified as significant determinants of response to therapy in older patients with acute myeloid leukemia, breast cancer, head and neck cancer, and lung cancer. The Charlson comorbidity index and adult comorbidity evaluation-27 are lists of comorbidities with a weight assigned from 1 to 6 for the former and from 0 to 3 for the latter score, derived from relative risk estimates of a proportional hazard regression model using clinical data. Design and Methods We retrospectively evaluated the Charlson index and adult comorbidity evaluation-27 score in a cohort of 125 elderly (> 60 years) patients with chronic phase chronic myeloid leukemia who received dasatinib after showing resistance or intolerance to imatinib with the aim of establishing associations between comorbidities and the development of pleural effusions or compliance with the drug treatment. Results We found a significant association between the Charlson index as well as the adult comorbidity evaluation-27 score and the rate of drug reduction or suspension: with regards to the Charlson index, 49% of score 0 patients had a dose reduction compared to 63% of patients with score 1, 74% of those with score 2 and 100% of patients with score 3-5 (P=0.03); with regards to the adult comorbidity evaluation-27 score, 45% of patients had score 0-1 and 69% of patients with score 2-3 had a dose reduction. Of the 65 patients with Charlson score 0, 29% had at least one suspension of treatment (79% for hematologic and 21% for non-hematologic toxicity), compared to 46% of patients with score 1 (37% for hematologic and 69% for non-hematologic toxicity), 58% of patients with score 2 (36% for hematologic and 64% for non-hematologic toxicity) and 100% of patients with score 3 or 4 (all patients for both types of toxicity). High adult comorbidity index-27 scores identified patients at high risk of grade 3/4 hematologic toxicity. Forty-one patients (32.8%) experienced pleural effusion during treatment: the highest scores for both indices were associated with an increased risk of pleural effusions. Conclusions In elderly patients with chronic myeloid leukemia treated with dasatinib, the rate of drug reduction or suspension and the incidence of pleural effusions seem to be associated with the presence of comorbidities: stratification according to the Charlson index and adult comorbidity evaluation-27 score before dasatinib therapy may enable the identification of patients at risk of major toxicities.
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收藏
页码:1457 / 1461
页数:5
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