老年血液病診療策略

,山西醫(yī)科大學(xué)附屬腫瘤醫(yī)院血液病診療中心,老年惡性血液病整體治療策略,蘇麗萍,2017-09-17太原,目錄,DIRECTORY,老年惡性血液病發(fā)病與治療現(xiàn)狀,01,老年惡性血液病的特點(diǎn),02,CGA參與的整體治療策略,03,總結(jié)和展望,04,老年惡性血液病發(fā)病與治療現(xiàn)狀,01,3,惡性血液病發(fā)病老齡化明顯,-,老年惡性血液病發(fā)病與治療現(xiàn)狀-發(fā)病老齡化,數(shù)據(jù)顯示血液病發(fā)病率與年齡呈正相關(guān)：無(wú)論是白血病還是淋巴瘤，60歲以上發(fā)病率均較60歲以下提高，特別是70歲以上，發(fā)病率提高了6-7倍，提示血液病老齡化明顯。,The American Cancer Society estimates the numbers of new cancer cases and deaths that will occur in the United States in the current year and compiles the most recent data on cancer incidence, mortality, and survival.,4,成人ALL發(fā)病率與年齡呈正相關(guān)，與總生存呈負(fù)相關(guān),-,老年惡性血液病發(fā)病與治療現(xiàn)狀-預(yù)后差,Blood. 2010;116(6):1011-1015.,55歲以下5年生存率30%以上，特別是小于30歲組，5年生存率60%以上，55-64歲組5年生存率下降為25%，65歲以上5年生存率不足10%，特別是85歲以上，不足5%。,The Swedish Acute Leukemia Registry is a true population-based registry that contains data on 3899 patients diagnosed in 1997 through 2006, there were 472 adult patients with ALL,5,AML發(fā)病率與年齡呈正相關(guān)，與總生存呈負(fù)相關(guān),-,老年惡性血液病發(fā)病與治療現(xiàn)狀預(yù)后差,Blood. 2009; 113:4179-4187.,The Swedish Acute Leukemia Registry (1997 through 2005),there were 2767 adult patients with AML .,小于50歲組5年生存率大于50%，55-64歲組，5年生存率22%左右，65-70歲組5年生存率下降為12%，70歲以上5年生存率不足5%,6,-,老年惡性血液病發(fā)病與治療現(xiàn)狀-治療是否可以獲益？,Ann Hematol. 2015; 94(7): 11271138.,部分老年白血病患者可以從治療中受益，但接受治療者不足50%,(66Yr),A.Patients were diagnosed between January 1, 2000 and December 31, 2009, 66 years, and continuously enrolled in Medicare Part A and B in the year prior to diagnosis. There were 3327 (40 %) patients who received chemotherapy within 3 months of diagnosis.,B. The median unadjusted overall survival was longer for patients treated with intensive therapy (18.9 months) compared to that with HMA therapy (6.6 months) and not treated (1.5 months; log rank p70 years) patients with DLBCL.,Results of comprehensive geriatric assessment effect survival in patients with malignant lymphoma,受試人群 ：Newly diagnosed patients with DLBCL aged70.,CGA: activities of dailyliving (ADL), instrumental activities of daily living (IADL) comorbidities (CIRS-G),The Oncologist. 2012;17:838846.,31,-,CGA參與治療實(shí)例分析,severe cardiopathy： NYHA class III or class IV or CIRS-G grade 3 or grade 4,32,-,CGA參與治療實(shí)例分析,Prognostic Factors,The Oncologist. 2012;17:838846.,33,-,CGA參與治療實(shí)例分析,The Oncologist. 2012;17:838846.,34,-,CGA參與治療實(shí)例分析,The 5-year OS, DFS, and EFS、 CSS rates were 60% 、 80%、 52%、74%,The Oncologist. 2012;17:838846.,OS,DFS,EFS,CSS,35,-,CGA參與治療實(shí)例分析,Patients Aged 80 Years,The Oncologist. 2012;17:838846.,36,-,CGA參與治療實(shí)例分析,The Oncologist. 2012;17:838846.,結(jié)論：1.Chemoimmunotherapy adjustments based on a CGA are associated with manageable toxicity and excellent outcomes in elderly patients with DLBCL. 2.Wide use of this CGA-driven treatment may result in better cure rates, especially in fit and unfit patients.,Results of comprehensive geriatric assessment effect survival in pa