scholarly journals Decitabine Versus Intensive Chemotherapy for Elderly Patients with Newly Diagnosed Acute Myeloid Leukemia

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 2713-2713 ◽  
Author(s):  
Eun-Ji Choi ◽  
Je-Hwan Lee ◽  
Han-Seung Park ◽  
Jung-Hee Lee ◽  
Miee Seol ◽  
...  
Keyword(s):  
Acute Myeloid Leukemia ◽  
Elderly Patients ◽  
Myeloid Leukemia ◽  
Treatment Options ◽  
Induction Treatment ◽  
Intensive Chemotherapy ◽  
Newly Diagnosed ◽  
Monosomy 7 ◽  
Elderly Aml ◽  
Acute Myeloid

Abstract Background Elderly patients with acute myeloid leukemia (AML) has generally poor prognosis prognosis in accordance with their unfavorable clinical and biologic features. Hypomethylating agents have shown potential in the treatment of AML as well as myelodysplastic syndrome (MDS). In this retrospective study, we compared the outcomes of elderly AML patients according to induction treatment options: decitabine versus intensive chemotherapy. We also tried to identify specific subsets of patients who are most likely to benefit from decitabine or intensive chemotherapy. Methods This study included elderly patients aged 65 years or older who received induction treatment with decitabine or intensive chemotherapy for newly diagnosed AML at a single institute. The endpoints for this study were overall survival (OS), response, and event-free survival (EFS). Response included complete remission (CR), CR with incomplete hematologic recovery (CRi), and CR with partial hematologic recovery (CRh). Results A total of 107 patients, decitabine for 75 and intensive chemotherapy for 32, were analyzed. Decitabine was given as 20 mg/m2/day for 5 days every 4 weeks. Median 5 courses (range, 1-43) were delivered to the patients and 16 patients were still on decitabine treatment at the time of analysis. Intensive chemotherapy regimens included cytarabine plus daunoruribin (n=21) or idarubicin (n=10), and hyper-CVAD (n=1): 25 patients received one course and 7 received two courses for induction treatment. The rate for CR + CRi + CRh (CRR) was 38.6% (39 of 101 assessable patients). With a median follow-up duration of 14.8 months (95% confidence interval [CI], 12.0-22.8) among surviving patients, 79 patients died and 22 relapsed. The median OS and EFS were 12.3 months (95% CI, 10.0-14.7) and 4.1 months (95% CI, 2.5-5.7), respectively. Decitabine showed lower CRR (26.1% vs. 65.6, P<0.001) with similar EFS (median 3.4 vs. 6.1 months, P=.338) and OS (median 11.0 vs. 14.8 months, P=.124) compared to intensive chemotherapy (Figure 1). Multivariate analysis demonstrated that induction treatment option, peripheral blood (PB) blast percentage, and leukemia type (secondary vs. de novo) were independent risk factors for CRR. A presence of FLT3-ITD mutation, complex karyotype, and higher PB blast percentage were independently associated with shorter OS. Subgroup analysis for OS showed that intensive chemotherapy was superior to decitabine in patients with FLT3-ITD mutation (median 9.5 vs. 2.6 months, P=.025) and poor cytogenetic risk (10.8 vs. 6.1 months, P=.027), but decitabine showed tendency towards a longer OS compared to intensive chemotherapy in those with monosomy 7 or del(7q) (11.7 vs. 3.3 months, P=.093; Figure 2). Conclusion Decitabine showed similar OS to intensive chemotherapy despite of lower response rate in elderly AML patients. Clinical outcomes of specific subgroups seemed to be different according to induction treatment options. Further studies are warranted for selection of optimal treatment options for elderly AML patients. Disclosures No relevant conflicts of interest to declare.

Decitabine Versus Intensive Chemotherapy for Elderly Patients With Newly Diagnosed Acute Myeloid Leukemia

2019 ◽  
Vol 19 (5) ◽  
pp. 290-299.e3
Author(s):  
Eun-Ji Choi ◽  
Je-Hwan Lee ◽  
Han-Seung Park ◽  
Jung-Hee Lee ◽  
Miee Seol ◽  
...  
Keyword(s):  
Acute Myeloid Leukemia ◽  
Elderly Patients ◽  
Myeloid Leukemia ◽  
Intensive Chemotherapy ◽  
Newly Diagnosed ◽  
Acute Myeloid

Induction Treatment In Elderly Patients with Acute Myeloid Leukemia (AML): Randomized Comparison of Intermediate-Dose Cytarabine Plus Mitoxantrone (IMA) Versus Standard-Dose Cytarabine Plus Daunorubicin (DA) In 492 AML Patients >60 Years – Results From the SAL 60plus Trial

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 334-334 ◽  
Author(s):  
Christoph Röllig ◽  
Michael Kramer ◽  
Mathias Hanel ◽  
Regina Herbst ◽  
Norbert Schmitz ◽  
...  
Keyword(s):  
Acute Myeloid Leukemia ◽  
Elderly Patients ◽  
Induction Therapy ◽  
Myeloid Leukemia ◽  
Induction Treatment ◽  
Term Survival ◽  
Elderly Aml ◽  
To Receive ◽  
Acute Myeloid ◽  
Intermediate Dose

Abstract Abstract 334 Background: The majority of patients diagnosed with Acute Myeloid Leukemia (AML) are older than 60 years. Although intensive induction chemotherapy is still the standard practice and a prerequisite for long-term survival, elderly patients have a higher risk of treatment related morbidity and lower remission rates than younger AML patients. An optimized induction treatment would combine high complete remission (CR) rates with tolerable toxicity. The combination of intermediate-dose cytarabine plus mitoxantrone (IMA) has recently been reported to result in high CR rates (73.5%) with acceptable toxicity in 86 elderly AML patients (Niederwieser et al., Blood 2002, abstr. 1337). We present the results of a randomized-controlled trial (RCT) comparing efficacy and tolerability of IMA with the standard 7+3 induction regimen consisting of daunorubicin plus cytarabine (DA). Patients and Method: In the 60plus trial of the Study Alliance Leukemia (SAL, former DSIL), AML patients >60 years considered medically fit for chemotherapy were randomized to receive either intermediate-dose cytarabine (1000 mg/m2 BID days 1,3,5,7) plus mitoxantrone (10 mg/m2 days 1–3) (IMA) or standard induction therapy with cytarabine (100 mg/m2 continuously days 1–7) plus daunorubicin (45 mg/m2 days 3–5) (DA). All patients who achieved a CR received cytarabine based consolidation treatment (2+5/MAMAC). Primary endpoint was the CR rate with an expected difference of 15% based on the results of the study named above. Secondary endpoints were the incidence of serious adverse events (SAEs), time to relapse (TTR), disease-free survival (DFS), and overall survival (OS). Result: A total of 492 patients with a median age of 69 years (range, 61–84) were enrolled between 2003 and 2009 by 29 German centers. 248 were randomized to receive IMA and 244 to receive DA. Patient characteristics were similar in the two treatment arms. In the intention-to-treat analysis, the CR rate was 59.3% (95% CI, 53.1–65.2) in the IMA arm and 51.2% (95%CI, 45.0–57.4) in the DA arm (p= 0.085). Mortality during the first 2 months after the start of study treatment was 18.1% and 18.4% in the IMA and the DA arm, respectively. Forty-five SAEs and grade-4 non hematological toxicities in 43 patients (19%) were reported in the IMA arm, while there were 57 SAEs in 52 patients in the DA arm (23%; p=0.1866). After a median follow-up time of 25.7 months (2.1 years), the median TTR is 10.3 months for IMA and 11.1 months for DA (p=0.328), the median DFS is 10.2 versus 11.7 months (p=0.11) and the median OS is 9.7 versus 10.8 months for IMA versus DA (p=0.945). This results in a 1-year OS of 43.6% in the IMA arm and 46.9% in the DA arm. Conclusion: Our current results show an equal efficacy and toxicity of both induction regimens. The trend for a higher CR rate after IMA does not translate into a survival advantage. Thus, our study indicates that elderly AML patients do not benefit from a dose escalation of cytarabine in induction therapy. Disclosures: No relevant conflicts of interest to declare.

A Homoharringtonine-Based Protocol Is Superior to Daunorubicin and Idarubicin-Based Protocols in Elderly Patients with Newly-Diagnosed Acute Myeloid Leukemia with Comparable Effects and Low Toxicities: Experience in a Chinese Center.

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 1946-1946
Author(s):  
Jianmin Wang ◽  
Shuqing Lü ◽  
Jianmin Yang ◽  
Xianmin Song ◽  
Li Chen ◽  
...  
Keyword(s):  
Acute Myeloid Leukemia ◽  
Elderly Patients ◽  
Myeloid Leukemia ◽  
Disease Free Survival ◽  
Early Death ◽  
Newly Diagnosed ◽  
Survival Times ◽  
Free Survival ◽  
Elderly Aml ◽  
Acute Myeloid

Abstract Homoharringtonine (HHT) is a plant alkaloid which has been used in China for the treatment of acute myeloid leukemia (AML) and chronic myeloid leukemia for over 30 years. We present here a retrospective analysis designed to compare the efficacy and toxicity of HHT with daunorubicin (DNR) and idarubicin for the treatment of AML in elderly patients. Fifty-three patients over 60 years with newly diagnosed non-M3 AML between January 1998 and December 2007 were treated with cytarabine (Ara-c, 100mg/m2/day for 7 days) in combination with HHT (2mg/m2/day for 7 days; HA group; n=19), or DNR (40mg/m2/d for 3 days; DA group; n=16), or idarubicin (8mg/m2/d for 3 days; IDA group; n=18). In the HA group, 42.1% (8/19) of patients achieved complete remission (CR), 26.3% (5/19) of patients had partial remission (PR). In the DA group, the CR and PR rates were each 18.8% (3/16). In the IDA group, 55.5% (10/18) of patients achieved CR, 5.9% (1/18) patients had PR. The CR and OR rates were not significantly different between the three groups. However, whereas in the IDA and DA groups the early death rate within one month after chemotherapy was 33.3% (6/18) and 23.5% (4/16) respectively, there was no early death in the HA group. The estimated OS (overall survival) times were 23.2±7.9 months, 7.6 ±2.1 months, 14.0±3.4 months in HA, DA, and IDA groups (HA versus DA, P = 0.048; HA versus IDA, P = 0.678). The estimated mean disease-free survival (DFS) time of those patients who achieved CR in the HA group (44.3±17.3) were also significantly higher than those in the DA group (7.8±2.7; P = 0.047), and comparable with those in the IDA group (18.0±4.2; P = 0.598). In summary, the response to HA induction therapy was at least equal to that of DA and IDA induction, with relatively mild extramedullary toxicity and lower myocardial toxicity. So HHT is a particularly suitable candidate for the treatment of elderly AML patients.

Selection of Elderly Acute Myeloid Leukemia Patients for Intensive Chemotherapy: Effectiveness of Intensive Chemotherapy and Subgroup Analysis

2014 ◽  
Vol 133 (3) ◽  
pp. 300-309 ◽  
Author(s):  
Dae Sik Kim ◽  
Ka Won Kang ◽  
Eun Sang Yu ◽  
Hong Jun Kim ◽  
Jung Sun Kim ◽  
...  
Keyword(s):  
Overall Survival ◽  
Acute Myeloid Leukemia ◽  
Elderly Patients ◽  
Subgroup Analysis ◽  
Myeloid Leukemia ◽  
Treatment Guideline ◽  
Definitive Treatment ◽  
Intensive Chemotherapy ◽  
Elderly Aml ◽  
Acute Myeloid

Background: Despite the advances in acute myeloid leukemia (AML) treatment, the prognosis of elderly patients remains poor and no definitive treatment guideline has been established. In the present study, we aimed to evaluate the effectiveness of intensive chemotherapy in elderly AML patients and to determine which subgroup of patients would be most responsive to the therapy. Methods: We retrospectively analyzed 84 elderly patients: 35, 19, and 30 patients were administered intensive chemotherapy, low-dose chemotherapy, and supportive care, respectively. Results: Among those who received intensive chemotherapy, there were 17 cases of remission after induction chemotherapy; treatment-related mortality was 22.9%. The median overall survival was 7.9 months. Multivariate analysis indicated that the significant prognostic factors for overall survival were performance status, fever before treatment, platelet count, blast count, cytogenetic risk category, and intensive chemotherapy. Subgroup analysis showed that intensive chemotherapy was markedly effective in the relatively younger patients (65-70 years) and those with de novo AML, better-to-intermediate cytogenetic risk, no fever before treatment, high albumin levels, and high lactate dehydrogenase levels. Conclusions: Elderly AML patients had better outcomes with intensive chemotherapy than with low-intensity chemotherapy. Thus, appropriate subgroup selection for intensive chemotherapy is likely to improve therapeutic outcome. © 2014 S. Karger AG, Basel

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