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1、ToddAFehnigerHematologyGrandRoundMarch13,2009Lenalidomidetherapyforuntreatedacutemyeloidleukemiainolderadults(>60yearsofage)DisclosureClinicalstudyfundedinpartbyCelgeneNon-FDAapproveduseofRevlimid(lenalidomide)Case71yoMpresentedwithdyspnea,fatigue,andpancytopeniaPerformancestat
2、us:ECOG1PMH:HTN,GERD,BPHPE:petechiae,paleCBCWBC1900/uL(ANC190/uL)Hgb6.7g/dLPlts74,000/uLfDifferential:33%blastsBlood113:1002,2009CaseBonemarrowbiopsyandaspirate30%cellular90%myeloblastsFABM0(undifferentiated)Flow:CD34+CD33+CD13+CD117+Routinecytogenetics:trisomy1347,XY+13[5]/46,
3、XY[15]FLT3ITD:PositiveBlood113:1002,2009Case:DxBoneMarrowandCytogeneticsBMAspirateLederstainAcuteMyeloidLeukemiainpatients>60yearoldMedianageofAMLis65-7013,410newAMLcases/8,990deathsin200714.5/100,000inadults>60years0.7/100,00inadults<60yearsMajorityofpatientsdonotreceivespecif
4、ictherapy(bestsupportivecare)Mediansurvival<1yearOlderAML:PrognosisandStandardTherapies?7+3:mediansurvival~8-13monthsLowdoseara-c:~9monthsNCCN:Investigationalagentsrecommendedas1stlinetherapyPrognosis,Resultswithcurrenttherapyoptions,andoverviewofinvestigationalagentsSummarized
5、inMikeMartin’sWashUHeme/OncgrandroundspresentationfromFebruary2008MartinandAbboud.BoodRev22:311,2008EliahEsteyJClinOncol25:1908,2007OlderAMLbiology:continuumwithmyelodysplasticsyndrome(MDS)CytogeneticsinolderAMLlowerpercentageoffavorableriskcytogeneticst(8;14),t(15;17),inv(16)H
6、igherpercentageofunfavorablecytogenetics-5,-7,+8,complexFrequentlyarisesfromMDSorinitialdiagnosesasAMLwithmultilineagedysplasiaResistanttotraditionalchemotherapy(MDR1)Presentationwitha‘hypoproliferative’,MDStypepicturecommonMDSandlenalidomideEfficacyoflenalidomideinMDS.ListAeta
7、l.NEJM352:5492005LenalidomideinMDSwith5qdeletion.ListAetal.NEJM355:1456,2006Phase2studyoflenalidomideintransfusion-dependent,lowandint-1riskMDSwithkaryotypesotherthandeletion5q.Blood111:86,2008.Asmallnumberofpatientswithclonalcytogeneticabnormalities(non-5q-)andexcessblastshadc
8、ytogeneticresponsesandCRs(IpresentedthistopicatWashUHe
