Treatment of Elderly Patients with Acute Myeloid Leukemia Adjusted to Age, Performance Status, Organ Function and the Presence of Co-Morbidities. Final Results of the Polish Adult Leukemia Group (PALG) 1/2005 Study.

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 1067-1067
Author(s):  
Bozena Katarzyna Budziszewska ◽  
Agnieszka Pluta ◽  
Kazimierz Sulek ◽  
Tadeusz Robak ◽  
Sebastian Giebel ◽  
...  
Keyword(s):  
Acute Myeloid Leukemia ◽  
Elderly Patients ◽  
Kidney Function ◽  
Myeloid Leukemia ◽  
Cox Model ◽  
Performance Status ◽  
Remission Induction ◽  
Frail Patients ◽  
Liver And Kidney ◽  
Acute Myeloid

Abstract Abstract 1067 Elderly patients with acute myeloid leukemia are heterogenous group with poor outcome. All age, biological status and co-morbidities limit applicability of intensive chemotherapy. The PALG elaborated original system allowing stratification of patients aged >60 years to three groups with different therapeutic approach. Altogether 537 patients with newly diagnosed AML and median age 70 years (range 60–93) were classified as 1) ‘fit’ (n=163): age 60–79y, ECOG 0–2, proper liver and kidney function, without comorbidities, 2) ‘unfit’ (n=210): age >60 years, ECOG 0–2, normal liver and kidney function, comorbidities allowed, 3) ‘frail’ (n=164): ECOG 3–4. According to PALG 1/2005 protocol ‘fit’ patients were treated similarly as younger adults with daunorubicin (DNR, 3 days) + cytarabine (AraC, 7 days) +/− cladribine, followed by DNR + AraC consolidation and maintenance. ‘Unfit’ patients received either two courses of AraC+DNR (2+5) or AraC (5 days) + thioguanine + methotrexate, followed by manitenance. ‘Frail’ patients were considered for palliative cytoreduction and supportive care. Results: Complete remission (CR) rate was 35% for ‘fit’, 22% for ‘unfit’ and 0% for ‘frail’ patients. Median survival in the respective groups equaled 39 weeks, 26 w., and 14 w., while the probability of survival at 1 year was 39%, 27% and 10%. The rate of early (up to 8 weeks) mortality was 31%, 24% and 31%, respectively. In the Cox model the only factor independently affecting the risk of overall mortality in both ‘fit’ and x‘unfit’ group was serum LDH above upper quartile (HR=2, p=0.005 for ‘fit’, HR=1.65, p=0.006 for ‘unfit’). Among ‘frail’ patients the risk of mortality was increased in patients with performance status ECOG>2 (HR=1.85, p=0.0008), initial WBC >8.5×10e9/L (HR=1.65, p=0.006), and bone marrow blasts >58% (HR=1.8, p=0.001). We conclude that the proposed stratification system is feasible for elderly AML patients and represets a model for further developments of individualized therapeutic approaches. Survival of patients in whom remission induction therapy may be applied depends on initial tumor burden as reflected by high serum LDH level. The outcome of patients referred for palliative treatment depends additionally on initial performance status. In contrast, neither age nor karyotype were found to independently affect outcome in this study. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Evaluation of Some Biochemical Parameters and Hormones In Patients with Acute Myeloid Leukemia in Iraq

2021 ◽  
pp. 1460-1466
Author(s):  
Hind Mahmood Jumaah ◽  
Jabbar H. Yenzeel ◽  
Mohammad G. Mehdi
Keyword(s):  
Acute Myeloid Leukemia ◽  
Liver Function ◽  
Kidney Function ◽  
Myeloid Leukemia ◽  
Biochemical Parameters ◽  
Serum Levels ◽  
Newly Diagnosed ◽  
Liver And Kidney ◽  
Kidney Functions ◽  
Acute Myeloid

 The effect of myeloid leukemia,  especially cute myeloid leukemia (AML), has been widely noticed on the parameters of liver and kidney functions and the levels of certain hormones. This study aimed to evaluate a number of biochemical parameters of liver and kidney functions and hormones in Iraqi subjects with newly diagnosed acute myeloid leukemia. Eighty newly diagnosed AML adult patients (40 males and 40 females) and forty healthy individuals (20 males and 20 females) with an age range of 16-75 years were involved in this study during their attendance at the Hematology Department of Baghdad Teaching Hospital/ Medical city in Baghdad province from March 2019 to February 2020. Blood samples were collected from all subjects for the determination of serum levels of the parameters of liver function parameters., kidney function , lactate dehydrogenase (LDH), and Erythropoietin (EPO). The results showed that the serum levels of liver function parameters (alanine aminotransferase (ALT), aspartate aminotransferase (AST), and alkaline phosphatase (ALP) had highly significant increases (p< 0.01)  in AML patients (85.87±2.49 , 53.93±1.76, 150.87±7.04 U/L, respectively) as compared  to the control (30.58 ±2.04, 22.89 ±0.97, 75.51 ±2.12 U/L, respectively ). Also, the level of kidney function parameters (blood urea, creatinine and uric acid) showed highly significant increases (p< 0.01) in AML patients (58.82 ±1.49, 1.831 ±0.05, 8.34 ±0.15 mg/dl, respectively) as compared to the control (31.10 ±1.03, 0.850 ±0.02, 4.81 ±0.14 mg/dl, respectively). In addition, the level of LDH showed a highly significant increase (p< 0.01) in the patients with AML (657.72 ±80.76 U/L) as compared to the control (166.05 ±6.15 U/L). Moreover, the level of EPO showed a highly significant increase (p<0.01) in the patients with AML (11763.80 ±329.46 pg/ml ) as compared  to the control (316.94 ±34.42 pg/ml).

Fludarabine, Cytarabine, and Attenuated-Dose Idarubicin (m-FLAI) Induction for Elderly Patients with Acute Myeloid Leukemia: Results of a Multicenter Phase II Study,

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 3626-3626
Author(s):  
Yoojoo Lim ◽  
Youngil Koh ◽  
Sung-Soo Yoon ◽  
Seonyang Park ◽  
Byoung Kook Kim ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Acute Myeloid Leukemia ◽  
Elderly Patients ◽  
Phase Ii ◽  
Myeloid Leukemia ◽  
Conflicts Of Interest ◽  
Performance Status ◽  
Free Survival ◽  
Induction Regimen ◽  
Acute Myeloid

Abstract Abstract 3626 Introduction: Although there have been remarkable improvements in treatment of acute myeloid leukemia (AML), the prognosis of AML in elderly patients remains poor, and the best induction chemotherapy for these patients remains yet unknown. To devise an effective induction regimen for elderly patients with AML, we conducted a phase II trial to evaluate the efficacy and safety of the modified fludarabine, cytarabine, and attenuated-dose idarubicin (m-FLAI) regimen in these patients. Patients and Methods: Elderly (60 years or older) AML patients who did not receive previous chemotherapy were enrolled. Patients received two consecutive cycles of m-FLAI chemotherapy as an induction. The m-FLAI regimen was comprised of fludarabine (25mg/m2, days 1–4), cytarabine (1000mg/m2, days 1–4), and attenuated-dose idarubicin (5mg/m2, days 1–3). The primary end point was complete remission (CR) rate. Results: A total of 108 patients (median age 68.4 years, M:F=64:44) were enrolled. CR was achieved in 62.9% of patients, and treatment-related mortality rate (TRM) was 25.8%. Median overall survival (OS) was 9.3 months, and median event-free survival (EFS) was 6.6 months. The mortality at 30 and 60 days was 18% and 24%, respectively. Performance status and comorbidity did not have prognostic value in these patients. Bone marrow expression of CD117 was related to long EFS and OS. Conclusion: In conclusion, m-FLAI is a safe and effective induction regimen for previously untreated AML in elderly patients. Bone marrow CD117 expression is an independent good prognostic factor in these patients. (ClinicalTrials.gov number, NCT01247493) Disclosures: No relevant conflicts of interest to declare.

Oral chemotherapeutic agents in elderly acute myeloid leukemia (AML) patients, a study from a developing country

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 7057-7057 ◽  
Author(s):  
S. Mukhopadhyay ◽  
P. Chitalkar ◽  
P. Gupta ◽  
U. Roy ◽  
A. Mukhopadhyay
Keyword(s):  
Acute Myeloid Leukemia ◽  
Elderly Patients ◽  
Developing Country ◽  
Myeloid Leukemia ◽  
Performance Status ◽  
Disease Free Survival ◽  
Normal Liver ◽  
The Elderly ◽  
Chemotherapeutic Agents ◽  
Acute Myeloid

7057 Background: Almost 60% of the patients with Acute Myeloid Leukemia (AML) are over the age of 60 years. Age is one of the strongest adverse prognostic factor for AML, both for induction remission and for survival. Studies have shown that elderly patients have reduced tolerance to aggressive chemotherapy especially the myelosupressive effects. Elderly patients with Leukemia who receive intensive treatment often die as a result of chemotherapy. Aggressive chemotherapy is also costly which the relatives in developing country are reluctant to spend for the elderly patients. The aim of our study was to see the outcome, tolerability and cost effectiveness of oral chemotherapeutic agents. Methods: We selected consecutive 100 patients more than 50 years of age in haemato oncology department of NCRI (Netaji Subhas Chandra Bose Cancer Research Institute) during the period from Jan 2004 to Dec 2006. The mean age of the patients was 65 (range 50 –71) years. There was male preponderance. The inclusion criteria were performance status more than 60% (Kornofsky), Morphological, Cyto-Chemical and Immunophenotyping diagnosis of Acute Myeloid Leukemia (AML), normal liver (billirubine < 2) and kidney function ( Creatinine <2%). After the incent consent all patient were started oral chemotherapeutic agents 6 Mercptopurine (6MP) 75mg/m2. Etoposide 70mg/m2 and Prednisolone 40mg/m2. All agents are given 3 weeks followed by 7 days gap every month and continued for 6 months. Bone Marrow was repeated after 3rd & 6th course of chemotherapy. Results: Fifteen (15%) and thirtyeight patients (38%) had complete hematological response after 3rd & 6th course of chemotherapy. Seven patients (7%) died because of grade III/IV Neutropenia. Median duration of Myelosupression was 18 days (2 to 48 days).12% required hospitalisation. With median follow up of 19 months (range 2–36 months) the disease free survival (DFS) and over all survival (OS) was 18 % and 32 % respectively. Conclusions: The combination of oral chemotherapeutic agents consisting of 6MP, Etoposide & Prednisolone were well tolerated by elderly patients with good induction remission, low mortality and median survival. It was cheaper and well accepted by the patients. No significant financial relationships to disclose.

Impact of CRi on the Outcome of Elderly Patients with Acute Myeloid Leukemia.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 4384-4384 ◽  
Author(s):  
Anne Etienne ◽  
Aude Charbonnier ◽  
Thomas Prebet ◽  
Diane Coso ◽  
Anne-Marie Stoppa ◽  
...  
Keyword(s):  
Acute Myeloid Leukemia ◽  
Elderly Patients ◽  
Induction Chemotherapy ◽  
Myeloid Leukemia ◽  
Disease Free Survival ◽  
New Drugs ◽  
Response Criteria ◽  
Remission Induction ◽  
Remission Duration ◽  
Acute Myeloid

Abstract New international recommendations of response for treatment of acute myeloid leukemia (AML) include morphologic complete remission with incomplete blood count recovery (CRi). This response criteria was defined following evaluation of new drugs used for the treatment of AML in first relapse (Sievers et al., JCO2001;19:3244–3254). The objective of our study was to determine the outcome of elderly patients with newly diagnosed AML achieving CRi. Between 1995 and 2006, 240 patients aged 65 years or older with previously untreated acute non promyelocytic leukemia received a conventional anthracycline and cytarabine induction chemotherapy at a single institution. Median age was 71 years (range, 65–85). One hundred and nineteen patients achieved a complete response (CR) (50%), 15 patients achieved CRi (6%), 69 patients had persisting leukemia (29%), and 37 died during remission induction therapy (15%). Patients who reached a CR or CRi after 1 or 2 cycles of induction chemotherapy proceeded to consolidation. Only 9 patients in CRi received this consolidation chemotherapy course (60%) and none had intensification (intermediate-dose cytarabine and/or autologous stem cell transplantation) whereas for patients achieving CR, 88% (n=104) and 69% (n=82) had consolidation and intensification, respectively (p=0,01 and p=0,03). The median overall survival (OS) was respectively 9 and 18 months for patients in CRi and CR (p=0,08). OS was significantly lower for patients in CRi younger than 70 years (5 versus 17 months for CR, p=0,02). By landmark analysis, there was no difference in OS between patients in CRi and a group of 67 patients with induction failure surviving at less 40 days (p=0,14). Disease-free survival (DFS) and remission duration were not significantly different between patients in CRi and CR overall (5 and 8 months, and 5 and 7 months, respectively), but we found a difference for patients younger than 70 years (p=0,004 and p=0,009 for DFS and remission duration, respectively). There was significantly more multilineage dysplasia in patients achieving CRi (8 versus 33, p=0,009) and platelet count at diagnosis were lower (44 G/L versus 82 G/L). Cytogenetic did not differ between the two groups. Our results show that the outcome of elderly patients who achieved CRi is inferior to patients in CR, especially for patients younger than 70 years. Although this response criteria seems to indicate activity, we were not able to found a difference with patients who did not achieve CR. This result will be revaluated in a larger study. Our data also suggest that patients with CRi have different initial disease characteristics. Figure Figure

5-Azacytidine to Treat Acute Myeloid Leukemia In Elderly or Frail Patients: A Phase II Study (SAKK 30/07)

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 2181-2181
Author(s):  
Jakob R. Passweg ◽  
Thomas Pabst ◽  
Sabine Blum ◽  
Mario Bargetzi ◽  
Hong Sun ◽  
...  
Keyword(s):  
Acute Myeloid Leukemia ◽  
Phase Ii ◽  
Myeloid Leukemia ◽  
Conflicts Of Interest ◽  
Performance Status ◽  
Hematologic Toxicity ◽  
Intensive Chemotherapy ◽  
Frail Patients ◽  
Patient Refusal ◽  
Acute Myeloid

Abstract Abstract 2181 Background: Acute Myeloid Leukemia (AML) in the elderly is notoriously difficult to treat and has a low remission rate with very few long term survivors when using standard treatment approaches. Azacytidine, a hypomethylating agent, has been shown to induce remission and prolong survival in patients with myelodysplastic syndromes; studying this approach to patients with AML is therefore warranted. We present results of an ongoing phase II trial treating elderly or frail AML patients with Azacytidine. Methods: AML elderly or frail patients, and therefore unfit for an intensive chemotherapy regimens, with a WHO performance status ≤ 3 were considered for this trial. Trial therapy consisted of 100mg/m2 of Azacytidine injected subcutaneously on 5 consecutive days every 28 days up to 6 cycles, stopping at 6 months if no hematological improvement achieved, or earlier in the case of progression or complications. Treatment was continued beyond 6 months in responding patients. Trial therapy was considered uninteresting if the response rate (CR + PR) within 6 months of therapy initiation was 15% or less and promising if 34% or more. Using the exact single-stage phase II design by A’Hern with a 5% significance level and 90% power, 43 patients were required: If 10 or fewer achieved a response within 6 months the trial therapy should not be considered for further investigation in its current format for this indication and patient population. Results: Between September 2008 and January 2010, 45 evaluable patients across 10 Swiss centers were accrued with a median follow-up of 7 months (range: 0 – 13). 27 (60%) were male, median age was 74 (range: 55 – 86) years and 35 (78.8%) had performance status 0–1. Patients had been excluded from more intensive chemotherapy regimens because of age (n = 37) or due to comorbidities or patient refusal (n=8). Five patients had therapy related AML. Patients received a median of 3 (range: 1 – 10) cycles. Treatment was stopped for not achieving a response by the 6th cycle in 2 patients and earlier in 26 patients (for disease progression in 5, toxicity in 3, patient refusal in 2, recurrent infections in 1, and death in 8). Seventeen patients remain on therapy. The median time spent in the hospital was 12 days (1 - 30) in 24/38 patients hospitalized during the first treatment cycle and 13 days (2 - 28) in 15/31 patients hospitalized during subsequent cycles. Adverse events of grade III or higher most frequently reported were constitutional or hematologic, i.e. fatigue in 5, febrile neutropenia in 8, infections in 6, dyspnea in 6, anemia in 3, neutropenia in 12 and thrombocytopenia in 10, hemorrhage in 2 and retinal detachment in 5. Based on available data on 38 patients, CR/CRi or hematologic improvement or stable disease within 6 months of trial registration was observed in a proportion of patients. Final and mature data, determining whether the predefined proportion of responding patients has been reached or not, will be presented at the conference. Up to now there were a total of 26 deaths. Median overall survival time was 5.7 months (95% CI: 3.1, 8.7). Conclusions: The current results of this slightly modified Azacytidine schedule demonstrate a feasible new therapy option for elderly or frail AML patients in an outpatient setting with moderate, mainly hematologic toxicity. Disclosures: No relevant conflicts of interest to declare.

Postremission treatment of elderly patients with acute myeloid leukemia in first complete remission after intensive induction chemotherapy:results of the multicenter randomized Acute Leukemia French Association (ALFA) 9803 trial

Blood ◽  
2007 ◽  
Vol 109 (12) ◽  
pp. 5129-5135 ◽  
Author(s):  
Claude Gardin ◽  
Pascal Turlure ◽  
Thierry Fagot ◽  
Xavier Thomas ◽  
Christine Terre ◽  
...  
Keyword(s):  
Overall Survival ◽  
Acute Myeloid Leukemia ◽  
Complete Remission ◽  
Elderly Patients ◽  
Myeloid Leukemia ◽  
Disease Free Survival ◽  
Remission Induction ◽  
Intensive Chemotherapy ◽  
Transfusion Requirements ◽  
Acute Myeloid

Abstract In elderly patients with acute myeloid leukemia (AML) treated intensively, no best postremission strategy has emerged yet. This clinical trial enrolled 416 patients with AML aged 65 years or older who were considered eligible for standard intensive chemotherapy, with a first randomization comparing idarubicin with daunorubicin for all treatment sequences. After induction, an ambulatory postremission strategy based on 6 consolidation cycles administered monthly in outpatients was randomly compared with an intensive strategy with a single intensive consolidation course similar to induction. Complete remission (CR) rate was 57% with 10% induction deaths, and estimated overall survival was 27% at 2 years and 12% at 4 years, without notable differences between anthracycline arms. Among the 236 patients who reached CR, 164 (69%) were randomized for the postremission comparison. In these patients, the multivariate odds ratio in favor of the ambulatory arm was 1.51 for disease-free survival (P =.05) and 1.59 for overall survival from CR (P =.04). Despite repeated courses of chemotherapy associated with a longer time under treatment, the ambulatory arm was associated with significantly shorter rehospitalization duration and lower red blood cell unit and platelet transfusion requirements than observed in the intensive arm. In conclusion, more prolonged ambulatory treatment should be preferred to intensive chemotherapy as postremission therapy in elderly patients with AML reaching CR after standard intensive remission induction.

scholarly journals A Proposal for a Novel Approach to Fitness in the Elderly Patients: The "NO-Chain" Algorithm

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 5943-5943
Author(s):  
Marta Riva ◽  
Alfredo Molteni ◽  
Roberto Cairoli
Keyword(s):  
Acute Myeloid Leukemia ◽  
Elderly Patients ◽  
Activities Of Daily Living ◽  
Functional Impairment ◽  
Daily Living ◽  
Myeloid Leukemia ◽  
Performance Status ◽  
Intensive Chemotherapy ◽  
Definition Of ◽  
Acute Myeloid

Abstract A proper assessment of elderly patients is a relevant clinical problem in the onco-hematological setting. In this context, age and extra-hematological morbidity are of primary importance, but performance status and overall functionality related to geriatric age, as physical abilities, cognitive aspects and ability to self-management are not negligible. Thus, a defined multi-dimensional assessment is needed to differentiate between fit, unfit and frail older adults (Klepin ASH Education Program 2014). We propose a tool to evaluate the tolerance to more or less intensive treatments in over 60 years aged patients, and to estimate the impact on the outcome. Our algorithm is based on 4 main variables universally recognized: age, performance status, comorbidities and geriatric aspects (functional, physical and cognitive). 1- As regards age, two cut-off values were considered: 70-years limit because it represents the threshold below which the allogeneic bone marrow transplantation may still run; and the 85-year limit because it denotes the edge beyond which chemotherapy (also non-intensive) should not be administered. 2- About performance status, it was chosen the ECOG (Eastern Cooperative Oncology Group) scale more or equal to 3 as the limit beyond which chemotherapy should be avoided. 3- Considering co-morbidities, the SIE, SIES GITMO group consensus-based definition of inability to intensive and non-intensive chemotherapy in acute myeloid leukemia (Ferrara et al. Leukemia 2013) was chosen to identify both patients candidate to intensive or candidate to only non-intensive chemotherapy. 4- Approaching the geriatric assessment, two levels of impairment were considered: the most important level of seriousness occurs when the Activities of Daily Living (ADL) functional scale is not overtaken; the lowest level of seriousness is verified if at least one among the functional Instrumental Activities of Daily Living (IADL) scale or the physical Short Physical Performace Battery (SPPB) scale or the cognitive Mini Mental State Examination (MMSE) scale are not overcome. The stratification of patients works with some steps that must be excluded in order to get over the various levels of fitness (Figure 1). We call this approach the NO-chain algorithm. It foresees that: - Patient with at least one of the following features are considered frail: 85 or more years of age; at least 3 of ECOG; assessed functional impairment with the ADL scale <3; presence of major comorbidities including at least one of the six criteria, according to the SIE, SIES GITMO consensus-based definition of inability to non-intensive chemotherapy in acute myeloid leukemia. - Not-frail patient with at least one of the following features are considered unfit: age over 70 years; at least one of criteria, according to the SIE, SIES GITMO consensus-based definition of inability to intensive chemotherapy in acute myeloid leukemia; at least one among functional impairment assessed by IADL scale <4 or reduced physical performance by SPPB scale <9 or intellectual deficit by the MMSE scale <24. - All patients who get through all these steps are considered fit and potentially eligible for allogeneic stem cell transplantation. Although the used cut-off levels might need amelioration in the practice, the basic principle of this algorithm is the definition of fitness actually correlated to the patient's condition in itself, regardless of the hematological disease. The algorithm was originally developed for elderly patients with acute myeloid leukemia (AML), but subsequently applied to patients with myelodysplastic syndrome (MDS) and to the other hematological malignancies. The application is undoubtedly different, depending on the disease the patient is affected by and its classification. For instance: an AML frail patients, regardless of biological risk, can be candidate only to supportive care; a low-risk MDS frail patients may still be candidate to pharmacological therapy as erythropoiesis stimulating agents or iron chelation therapy. The validation of this algorithm has to be carried out within each hematologic malignancy and must take into account the specific application. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

Comparison of Outcome and Prognosis of 248 Elderly Patients with Acute Myeloid Leukemia Treated with Standard-Dose or Low-Intensity Induction Therapy

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 2540-2540
Author(s):  
Jianda Hu ◽  
Yi Chen ◽  
Xiaoyun Zheng ◽  
Zhihong Zheng ◽  
Ting Yang ◽  
...  
Keyword(s):  
Acute Myeloid Leukemia ◽  
Prognostic Factors ◽  
Elderly Patients ◽  
Induction Therapy ◽  
Myeloid Leukemia ◽  
Standard Dose ◽  
Performance Status ◽  
Low Intensity ◽  
Induction Cycle ◽  
Acute Myeloid

Abstract Acute myeloid leukemia (AML) is a disease of older adults, with a median onset age at about 65-70 years. The treatment outcome of AML appears to be poorer with the age increasing, in part due to the poor performance status, concomitant end-organ dysfunction, higher incidence of unfavorable cytogenetic findings, frequent involvement of a more immature leukemic precursor clone, multidrug resistance mediated by MDR1/P-glycoprotein, and the presence of antecedent hematopoietic disorders. Treatment of elderly patients with AML remains highly challenging and controversial. The overall survival rates at 5-year of ≥ 60 years old AML patients are still less than 20% by now. At present, standard-dose induction chemotherapy using a cytarabine plus idarubicin(IA regimen) or daunorubicin (DA regimen) was considered by most to be the most effective upfront AML induction therapy. However, there are still quite a number of elderly patients could not tolerate because of poor performance status and complications. Therefore, low-intensity chemotherapy, including CAG regimen, which combine low-dose cytarabine, aclacinomycin and granulocyte colony-stimulating factor(G-CSF), was used for those were not appropriate for receiving standard-dose chemotherapy. Here we retrospectively analyzed the outcome and prognosis of elderly patients with AML treated with standard-dose or low-intensity induction therapy. 248 elderly patients with acute myeloid leukemia(AML) who received standard-dose or low-intensity induction therapy were enrolled in this retrospective clinical study, 186 patients in standard-dose group with 144 in IA and 42 in DA, 62 cases in low-intensityCAG group. The maininclusion criteria included age ≥ 60 years old, ECOG performance status ≤ 2, without severe complication of heart, liver, kidney or other important organ. The patients received standard-dose or low-intensity induction regimen according to their performance status and patient preference. 144 patients received IA regimen(idarubicin 10mg/m2/d ,d1-3; cytarabine 100mg/m2, q12h, d1-5 or 7), 42 patients received DA regimen(daunorubicin 60mg/m2/d, d1-3; cytarabine 100mg/m2 q12h, d1-5 or 7), and 62 patients received CAG regimen (cytarabine 10mg/m2 q12h, d1-14; aclacinomycin 20mg qd, d1-4; G-CSF 200ug/m2 qd, d0-14, or until bone marrow recover). The median survival time was 9.2 months. 1-year , 3-year and 5-year overall survival(OS) were 42.2%, 18.9% and 13.5%, respectively. After first induction cycle, complete remission(CR) rate was 49.3% in IA group, 35.7% in DA group and 32.3% in CAG group (P = 0.046). The median OS for IA, DA and CAG group were 10.0 months, 9.7months and 7.5 months, respectively. The early mortality of induction therapy and recurrence rate of three regimens showed no difference. IA could improve the long term survival compared to CAG and DA, with 3-year OS: 23.5%,15.9% and 8.3%, respectively; 5-year OS: 19.4%, 6.3%, and 0, respectively (P<0.01). The 67.0% patients relapsed within 24 months, with median relapse time of 8.4 months, 14.6 months and 8.3 months for IA, DA and CAG regimen, respectively. Moreover, Kaplan-Meier analysis showed that 7 parameters were adverse prognostic factors for OS, including age ≥ 70 years old, poor ECOG performance status, unfavorable cytogenetics, non-remission after first induction cycle, white blood cell (WBC) counts ≥ 50×10^9/L, percentage of bone marrow (BM) blast ≥ 80% and higher lactic dehydrogenase (LDH) . Multivariable analysis identified non-remission after first induction cycle (HR = 6.141, 95%CI: 3.585-10.52, P = 0.000) and LDH ≥ 490 IU/L(HR = 1.001, 95%CI: 1.000-1.001, P = 0.000) as independent significantly prognostic factors for OS. In conclusion, Our present data showed that standard-dose IA regimen could improve CR rate and prolong the survival time compared to low-intensity CAG regimen, and CAG regimen still has a certain therapeutic effect for those unfit for intensive chemotherapy. Recurrence is still a serious problem for those who do not receive Allo-HSCT for consolidation after CR. All prognostic factors should be considered before induction therapy to make sure the patients receive the best individualized treatment. Disclosures No relevant conflicts of interest to declare.

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