J Clin Oncol:原发性血小板增多症:羟基脲与阿司匹林联用效果如何?

2018-09-28 张琪 环球医学网

发表于《J Clin Oncol》上的一项研究,考察了羟基脲+阿司匹林 vs阿司匹林单药治疗40~59岁无高血栓风险特征的原发性血小板增多症(ET)的效果。

发表于《J Clin Oncol》上的一项研究,考察了羟基脲+阿司匹林 vs阿司匹林单药治疗40~59岁无高血栓风险特征的原发性血小板增多症(ET)的效果。

目的:细胞减灭术对具有高血栓风险的ET患者是有益的。但是,其对不伴高风险特征患者的价值仍不清楚。这项开放式标签、随机试验对比羟基脲+阿司匹林和阿司匹林单用治疗40~59岁无高风险因素或极端血小板增多症(血小板计数≥1500×109/L)的ET患者。

患者和方法:患者年龄为40~59岁,无缺血、血栓、栓塞、出血、极端血小板增多症、高血压或需要治疗的糖尿病病史。总共382名患者被随机分配至(1:1)羟基脲+阿司匹林组或阿司匹林单药组。主要复合终点是动脉或静脉血栓形成、严重出血或血管原因引起的死亡。次要终点是首次动脉或静脉血栓形成时间、首次严重出血、死亡、转变发生率和报道的患者生活质量。

结果:在中位随访期73个月和总随访2373患-年后,两组患者达到主要终点的可能性没有明显差异(风险比,0.98;95%CI,0.42~2.25;P=1.0)。明显血管事件的发生率是较低的,为每100患者-年中有0.93(95% CI,0.61~1.41)。总生存期,转变为骨髓纤维化、急性髓性白血病或骨髓增生异常的复合终点,不良事件,或患者报道的生活质量没有差异。

结论:在40~59岁且无高血栓风险因素或极端血小板增多症的ET患者中,优先联用羟基脲和阿司匹林不会降低血管事件、骨髓纤维化转化率或白血病转化率。年龄为40~59岁,血小板计数<1500×109/L且无其他治疗临床适应症需治疗(例如:既往血栓形成或出血)的患者不应接受细胞减灭术。
原始出处:
Godfrey AL, Campbell PJ, MacLean C, et al.Hydroxycarbamide Plus Aspirin Versus Aspirin Alone in Patients With Essential Thrombocythemia Age 40 to 59 Years Without High-Risk Features.J Clin Oncol. 2018 Aug 28:JCO2018788414. doi: 10.1200/JCO.2018.78.8414. [Epub ahead of print]

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    2018-11-15 minlingfeng
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    2018-09-28 CHANGE

    疗效只是效果的众多方面之一,还要看对患者的获益,包括生活质量等因素共同决定效果的

    0

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