Erythropoietin treatment in patients with myelodysplastic syndromes and type 2 diabetes 促红细胞生成素治疗骨髓增生异常综合征合并2型糖尿病的患者

Background The aim of the present study was to assess the role of a concomitant type 2 diabetes as a potentially negative factor in the management of low-risk myelodysplastic syndrome (MDS) patients treated with high-dose (40 000 UI s.c. 2 times/week) recombinant human erythropoietin (EPO) alpha (rHuEPO alpha). Methods One hundred and forty patients (M/F 69/71, median age 76, interquartile range [IR] 68–81) were included in the analysis: 27/140 (19.2%) had a concomitant type 2 diabetes. Results No difference was reported between patients with and without diabetes as to the grade of anemia, the EPO endogenous levels and the need for transfusional requirement at baseline. Erythroid response was achieved in 79/140 patients (56.4%): factors associated with response were lower EPO levels (P < 0.0001), higher baseline Hb levels (P < 0.0001) and transfusion independence (P < 0.0001). Diabetes was not predictive of response: 17/27 (62.9%) patients with diabetes were responsive to high-dose EPO compared with 62/113 (54.8%) patients without diabetes (P = 0.446). This was confirmed in multivariate analysis, controlling for the effects of Hb levels, transfusion-dependence and serum EPO levels. No difference was observed in relapse rate, response duration and OS between patients with and without diabetes. Conclusions Concomitant type 2 diabetes was not a major concern in the management of MDS patients. 摘要 背景： 本研究的目的是评估对低危骨髓增生异常综合征（myelodysplastic syndrome，MDS）患者使用高剂量（40000 UI 2次/周皮下注射）重组人促红细胞生成素（human erythropoietin，EPO）α（rHuEPOα）治疗时，患者合并2型糖尿病的潜在负面影响。 方法： 有140名患者（男/女：69/71，中位数年龄为76岁，四分位范围[IR]为68–81岁）被纳入分析：有27人/140（19.2%）合并2型糖尿病。 结果： 合并糖尿病的患者与不合并糖尿病的患者相比，基线时报告的贫血分级、内源性EPO水平以及需要的输血量都没有差异。79/140（56.4%）名患者的红细胞系统有应答：与应答有关的因素为更低的EPO水平（P < 0.0001）、更高的基线Hb水平（P < 0.0001）以及不依赖输血（P < 0.0001）。糖尿病并不是应答的预测因子：17/27（62.9%）名合并糖尿病的患者对高剂量EPO有应答，而对照的没有合并糖尿病的患者比例为62/113（54.8%）（P = 0.446）。在多元分析中排除了Hb水平、不依赖输血以及血清EPO水平的影响之后，这一点得到了证实。在合并糖尿病与不合并糖尿病的患者之间没有观察到复发率、应答持续时间以及OS的差异。 结论： MDS患者的管理中合并2型糖尿病并不是一个大问题。