백혈병 비만환자의 체중 적용 기준에 따른 항암치료 효과 및 안전성 비교
Efficacy and Safety of Chemotherapy Dosed on Actual or Adjusted Body Weight in Obese Patients with Leukemia
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Background : There are no clear guidelines for setting anticancer drug doses in obese hematological cancer patients. Based on the reports that toxicity will not increase significantly, the weight application criteria for chemotherapy dose in acute leukemia was changed from the adjusted body weight (AdjBW) to the actual body weight (ABW) in August 2020. In this study, we compared the efficacy and safety between the AdjBW and ABW groups and evaluated the appropriateness of the criteria change. Methods : From January 2019 to June 2021, the study was conducted on obese acute leukemia patients at Seoul St. Mary’s Hospital. The efficacy between the AdjBW and ABW groups was compared; whether each group reached complete remission (CR) and mortality within 30 days and recurrence within 6 months. The safety was evaluated by analyzing the recovery period of absolute neutrophils and platelets, bacteremia occurrence, and hospitalization period. Results : There were no significant differences in the CR rate (84.6% vs 76.5%, p=0.502), mortality within 30 days (0% vs 4.8%, p=0.206), and recurrence within 6 months (6.7% vs 21.1%, p=0.24) between the groups after induction of chemotherapy. Recovery period of absolute neutrophils (21.51±4.2 days vs 20.69±6.48 days, p=0.412) and platelets (27.02±10 days vs 30.11±27 days, p=0.409), bacteremia occurrence (70.8% vs 56.9%, p=0.109), and hospitalization period (28.46±6.84 days vs 26.41±7.4 days, p=0.117) were not significantly different between the two groups, but the number of neutropenic fever was higher in the ABW group (1.60±1.08 times vs 1.12±0.89 times, p=0.01). Conclusion : Preemptive anticancer dose reductions for obesity did not influence the composite endpoint of efficacy and safety. Therefore, changing the weight application criteria is considered appropriate from the point of view that it may help to obtain the maximum effect within the tolerable toxicity by patients.
Abstract
Background : There are no clear guidelines for setting anticancer drug doses in obese hematological cancer patients. Based on the reports that toxicity will not increase significantly, the weight application criteria for chemotherapy dose in acute leukemia was changed from the adjusted body weight (AdjBW) to the actual body weight (ABW) in August 2020. In this study, we compared the efficacy and safety between the AdjBW and ABW groups and evaluated the appropriateness of the criteria change. Methods : From January 2019 to June 2021, the study was conducted on obese acute leukemia patients at Seoul St. Mary’s Hospital. The efficacy between the AdjBW and ABW groups was compared; whether each group reached complete remission (CR) and mortality within 30 days and recurrence within 6 months. The safety was evaluated by analyzing the recovery period of absolute neutrophils and platelets, bacteremia occurrence, and hospitalization period. Results : There were no significant differences in the CR rate (84.6% vs 76.5%, p=0.502), mortality within 30 days (0% vs 4.8%, p=0.206), and recurrence within 6 months (6.7% vs 21.1%, p=0.24) between the groups after induction of chemotherapy. Recovery period of absolute neutrophils (21.51±4.2 days vs 20.69±6.48 days, p=0.412) and platelets (27.02±10 days vs 30.11±27 days, p=0.409), bacteremia occurrence (70.8% vs 56.9%, p=0.109), and hospitalization period (28.46±6.84 days vs 26.41±7.4 days, p=0.117) were not significantly different between the two groups, but the number of neutropenic fever was higher in the ABW group (1.60±1.08 times vs 1.12±0.89 times, p=0.01). Conclusion : Preemptive anticancer dose reductions for obesity did not influence the composite endpoint of efficacy and safety. Therefore, changing the weight application criteria is considered appropriate from the point of view that it may help to obtain the maximum effect within the tolerable toxicity by patients.
참고문헌 (24)
- Vucenik I, "Obesity and cancer risk: evidence, mechanisms, and recommendations", Annals of the New York Academy of Sciences, 1271(1), pp.37~43 (2012)
- 오상우, "국내 비만의 최신 역학적 변화 양상", Korean Journal of Helicobacter Upper Gastrointestinal Research, 17(2), pp.62~65 (2017), 대한상부위장관ㆍ헬리코박터학회[DOI]
- Calle EE, "Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults", N Engl J Med, 348(17), pp.1625~1638 (2003)
- Leykin Y, "Pharmacokinetic considerations in the obese", Best Pract Res Clin Anaesthesiol, 25(1), pp.27~36 (2011)
- Shem-Tov N, "Chemotherapy dose adjustment for obese patients undergoing hematopoietic stem cell transplantation: a survey on behalf of the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation", Oncologist, 20(1), pp.50~55 (2015)
- Griggs JJ, "Appropriate Chemotherapy Dosing for Obese Adult Patients With Cancer:American Society of Clinical Oncology Clinical Practice Guideline", J Oncol Pract, 8(4), pp.e59~e61 (2012)
- Griggs JJ, "Appropriate Systemic Therapy Dosing for Obese Adult Patients With Cancer ASCO Guideline Update", J Clin Oncol, 39(18), pp.2037~2048 (2021)
- Wenzell CM, "Outcomes in obese and overweight acute myeloid leukemia patients receiving chemotherapy dosed according to actual body weight", Am J Hematol, 88(10), pp.906~909 (2013)
- Medeiros BC, "Impact of body-mass index on the outcome of adult patients with acute myeloid leukemia", Haematologica, 97(9), pp.1401~1404 (2012)
- Lin A, "Influence of obesity on efficacy and toxicity of induction chemotherapy in patients with newly diagnosed acute myeloid leukemia", Leuk Lymphoma, 54(3), pp.541~546 (2013)
- Peric KM, "Tolerability of induction chemotherapy dosing practices in acute myeloid leukemia patients", Leuk Res, 39(2), pp.173~176 (2015)
- Bray WM, "Outcomes for newly diagnosed patients with acute myeloid leukemia dosed on actual or adjusted body weight", Cancer Chemother Pharmacol, 76(4), pp.691~697 (2015)
- 정통령, "체질량지수와 이상체중을 이용한 비만도 판정기준간의 일치도 비교", J Korean Acad Fam Med, 22(12), pp.1765~1771 (2001)
- Martin S, "Acute Myeloid Leukemia, Version 3", NCCN Clinical Practice Guidelines in Oncology, ~ (2020)
- Canal P, "Practical treatment guide for dose individualisation in cancer chemotherapy", Drugs, 56(6), pp.1019~1038 (1998)
- Shultes KC, "Impact of Dose-Adjusted Melphalan in Obese Patients Undergoing Autologous Stem Cell Transplantation", Biol Blood Marrow Transplant, 24(4), pp.687~693 (2018)
- Hunter RJ, "Dosing chemotherapy in obese patients:actual versus assigned body surface area (BSA)", Cancer Treat Rev, 35(1), pp.69~78 (2009)
- Lyman GH, "Impact of chemotherapy dose intensity on cancer patient outcomes", J Natl Compr Canc Netw, 7(1), pp.99~108 (2009)
- Carroll JP, "Toxicity and tolerability of adjuvant breast cancer chemotherapy in obese women", Med Oncol, 31(4), pp.881~ (2014)
- Chambers P, "Chemotherapy dose reductions in obese patients with colorectal cancer", Ann Oncol, 23(3), pp.748~753 (2012)
- Chan H, "Obese non-Hodgkin lymphoma patients tolerate full uncapped doses of chemotherapy with no increase in toxicity, and a similar survival to that seen in nonobese patients", Leuk Lymphoma, 57(11), pp.2584~2592 (2016)
- Barrett SV, "Does body mass index affect progression-free or overall survival in patients with ovarian cancer? Results from SCOTROC I trial", Ann Oncol, 19(5), pp.898~902 (2008)
- Colleoni M, "Relation between chemotherapy dose, oestrogen receptor expression, and bodymass index", Lancet, 366(9491), pp.1108~1110 (2005)
- Au-Yeung G, "Impact of obesity on chemotherapy dosing for women with advanced stage serous ovarian cancer in the Australian Ovarian Cancer Study (AOCS)", Gynecol Oncol, 133(1), pp.16~22 (2014)