老年血液病诊疗策略

,山西医科大学附属肿瘤医院血液病诊疗中心,老年恶性血液病整体治疗策略,苏丽萍,2017-09-17太原,目录,DIRECTORY,老年恶性血液病发病与治疗现状,01,老年恶性血液病的特点,02,CGA参与的整体治疗策略,03,总结和展望,04,老年恶性血液病发病与治疗现状,01,3,恶性血液病发病老龄化明显,-,老年恶性血液病发病与治疗现状-发病老龄化,数据显示血液病发病率与年龄呈正相关：无论是白血病还是淋巴瘤，60岁以上发病率均较60岁以下提高，特别是70岁以上，发病率提高了6-7倍，提示血液病老龄化明显。,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发病率与年龄呈正相关，与总生存呈负相关,-,老年恶性血液病发病与治疗现状-预后差,Blood. 2010;116(6):1011-1015.,55岁以下5年生存率30%以上，特别是小于30岁组，5年生存率60%以上，55-64岁组5年生存率下降为25%，65岁以上5年生存率不足10%，特别是85岁以上，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发病率与年龄呈正相关，与总生存呈负相关,-,老年恶性血液病发病与治疗现状预后差,Blood. 2009; 113:4179-4187.,The Swedish Acute Leukemia Registry (1997 through 2005),there were 2767 adult patients with AML .,小于50岁组5年生存率大于50%，55-64岁组，5年生存率22%左右，65-70岁组5年生存率下降为12%，70岁以上5年生存率不足5%,6,-,老年恶性血液病发病与治疗现状-治疗是否可以获益？,Ann Hematol. 2015; 94(7): 11271138.,部分老年白血病患者可以从治疗中受益，但接受治疗者不足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,受试人群 ：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参与治疗实例分析,severe cardiopathy： NYHA class III or class IV or CIRS-G grade 3 or grade 4,32,-,CGA参与治疗实例分析,Prognostic Factors,The Oncologist. 2012;17:838846.,33,-,CGA参与治疗实例分析,The Oncologist. 2012;17:838846.,34,-,CGA参与治疗实例分析,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参与治疗实例分析,Patients Aged 80 Years,The Oncologist. 2012;17:838846.,36,-,CGA参与治疗实例分析,The Oncologist. 2012;17:838846.,结论：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