Jihane Fattoum1, Giovanna Cannas1, Mohamed Elhamri1, Isabelle Tigaud2, Adriana Plesa3, Maël Heiblig1, Claudiu Plesa4, Eric Wattel1, Xavier Thomas5. 1. Department of Hematology, Lyon-Sud Hospital, Hospices Civils de Lyon, Pierre Bénite, France. 2. Laboratory of Cytogenetics, Lyon-Sud Hospital, Hospices Civils de Lyon, Pierre Bénite, France. 3. Laboratory of Cytology and Immunology, Lyon-Sud Hospital, Hospices Civils de Lyon, Pierre Bénite, France. 4. Hematology, Trarieux Clinic, Lyon, France. 5. Department of Hematology, Lyon-Sud Hospital, Hospices Civils de Lyon, Pierre Bénite, France. Electronic address: xavier.thomas@chu-lyon.fr.
Abstract
BACKGROUND: Patients aged ≥ 70 years with acute myeloid leukemia (AML) have a poorer prognosis than those aged 60 to 69 years. PATIENTS AND METHODS: We retrospectively analyzed the cases of 183 patients aged ≥ 70 years with a performance status of ≤ 2 treated at our institution from 2000 to 2014. Treatment consisted of anthracycline- and cytarabine-based chemotherapy for 93 patients and lower intensity therapy with low-dose cytarabine or hypomethylating agent cycles for 90 patients. RESULTS: A total of 57 patients (61%) achieved complete remission in the intensive chemotherapy group versus only 11 (12%) in the lower intensity treatment group (P < .0001). The median overall survival (OS) was 14.5 months and 11.7 months with a 3-year OS rate of 34% and 18% (P = .005) for the intensive and lower intensity groups, respectively. The difference remained significant when considering patients aged ≤ 75 years, but not for patients aged > 75 years. Similarly, a significant difference was only observed when considering favorable and intermediate cytogenetic factors (P = .007) but not unfavorable karyotypes. On multivariate analysis, age did not appear as an independent prognostic factor. CONCLUSION: With intensive chemotherapy, the median OS significantly increased after the introduction of an improved supportive care policy compared with historical controls (14 vs. 5.4 months, with a 3-year OS rate of 33% vs. 8%). After 2006, a more "personalized" therapeutic approach tended to erase the difference in terms of OS, especially in patients aged > 75 years.
BACKGROUND:Patients aged ≥ 70 years with acute myeloid leukemia (AML) have a poorer prognosis than those aged 60 to 69 years. PATIENTS AND METHODS: We retrospectively analyzed the cases of 183 patients aged ≥ 70 years with a performance status of ≤ 2 treated at our institution from 2000 to 2014. Treatment consisted of anthracycline- and cytarabine-based chemotherapy for 93 patients and lower intensity therapy with low-dose cytarabine or hypomethylating agent cycles for 90 patients. RESULTS: A total of 57 patients (61%) achieved complete remission in the intensive chemotherapy group versus only 11 (12%) in the lower intensity treatment group (P < .0001). The median overall survival (OS) was 14.5 months and 11.7 months with a 3-year OS rate of 34% and 18% (P = .005) for the intensive and lower intensity groups, respectively. The difference remained significant when considering patients aged ≤ 75 years, but not for patients aged > 75 years. Similarly, a significant difference was only observed when considering favorable and intermediate cytogenetic factors (P = .007) but not unfavorable karyotypes. On multivariate analysis, age did not appear as an independent prognostic factor. CONCLUSION: With intensive chemotherapy, the median OS significantly increased after the introduction of an improved supportive care policy compared with historical controls (14 vs. 5.4 months, with a 3-year OS rate of 33% vs. 8%). After 2006, a more "personalized" therapeutic approach tended to erase the difference in terms of OS, especially in patients aged > 75 years.
Authors: Mikkael A Sekeres; Gordon Guyatt; Gregory Abel; Shabbir Alibhai; Jessica K Altman; Rena Buckstein; Hannah Choe; Pinkal Desai; Harry Erba; Christopher S Hourigan; Thomas W LeBlanc; Mark Litzow; Janet MacEachern; Laura C Michaelis; Sudipto Mukherjee; Kristen O'Dwyer; Ashley Rosko; Richard Stone; Arnav Agarwal; L E Colunga-Lozano; Yaping Chang; QiuKui Hao; Romina Brignardello-Petersen Journal: Blood Adv Date: 2020-08-11
Authors: Yaping Chang; Gordon H Guyatt; Trevor Teich; Jamie L Dawdy; Shaneela Shahid; Jessica K Altman; Richard M Stone; Mikkael A Sekeres; Sudipto Mukherjee; Thomas W LeBlanc; Gregory A Abel; Christopher S Hourigan; Mark R Litzow; Laura C Michaelis; Shabbir M H Alibhai; Pinkal Desai; Rena Buckstein; Janet MacEachern; Romina Brignardello-Petersen Journal: PLoS One Date: 2021-03-30 Impact factor: 3.240