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Acute Myeloid Leukemia
Ferrata Storti Foundation
Haematologica 2020 Volume 105(2):398-406
Comparisons of commonly used front-line regimens on survival outcomes in patients aged 70 years and older with acute myeloid leukemia
Chetasi Talati,1 Varun C Dhulipala,2 Martine Extermann,3,4 Najla Al Ali,1 Jongphil Kim,2,5 Rami Komrokji,1,6 Kendra Sweet,1,6 Andrew Kuykendall,1,2 Marina Sehovic,1 Tea Reljic,2 Benjamin Djulbegovic,1,2 and Jeffrey E. Lancet1,6
1H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; 2Maury Regional Cancer Center, Columbia, TN; 3Senior Adult Oncology Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; 4Department of Oncology Sciences, University of South Florida, Tampa, FL; 5Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, FL and 6Malignant Hematology Department, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
ABSTRACT
In older patients with acute myeloid leukemia, the more frequent pres- ence of biologically inherent therapy-resistant disease and increased comorbidities translate to poor overall survival and therapeutic chal- lenges. Optimal front-line therapies for older patients with acute myeloid leukemia remain controversial. We retrospectively evaluated survival out- comes in 980 elderly (≥70 years) acute myeloid leukemia patients from a single institution between 1995 and 2016. Four treatment categories were compared: high-intensity (daunorubicin/cytarabine or equivalent), hypomethylating agent, low-intensity (low-dose cytarabine or similar without hypomethylating agents), and supportive care therapy (including hydroxyurea). At a median follow up of 20.5 months, the median overall survival for the entire cohort was 7.1 months. Multivariate analysis identi- fied secondary acute myeloid leukemia, poor-risk cytogenetics, perform- ance status, front-line therapy, age, white blood cell count, platelet count, and hemoglobin level at diagnosis as having an impact on survival. High- intensity therapy was used in 360 patients (36.7%), hypomethylating agent in 255 (26.0%), low-intensity therapy in 91 (9.3%), and supportive care in 274 (28.0%). Pairwise comparisons between hypomethylating agent thera- py and the three other treatment groups demonstrated statistically signifi- cant superior median overall survival with hypomethylating agent [14.4 months) vs. high-intensity therapy 10.8 months, hazard ratio 1.35, 95% confidence interval (CI): 1.10-1.65; P=0.004], low-intensity therapy (5.9 months, hazard ratio 2.01, 95%CI: 1.53-2.62; P<0.0001), and supportive care (2.1 months, hazard ratio 2.94, 95%CI: 2.39-3.61; P<0.0001). Our results indicate a significant survival benefit with hypomethylating agents compared to high-intensity, low-intensity, or supportive care. Additionally, high-intensity chemotherapy resulted in superior overall outcomes com- pared to low-intensity therapy and supportive care. Results from this study highlight the need for novel therapeutic approaches besides utilization of intensive chemotherapy in this specific aged population.
Introduction
The incidence of acute myeloid leukemia (AML) increases with age, with a median age of ≥65 years at time of diagnosis.1-3 Between 1975 and 2001, the 5-year survival of younger AML patients has more than doubled, yet the survival of patients over the age of 65 continues to remain dismal. These differences can pri- marily be attributed to the clinical and functional heterogeneity of disease in eld- erly patients. Compared with their younger counterparts, older patients have AML
Correspondence:
CHETASI TALATI
chetasi.talati@gmail.com
Received: October 9, 2018. Accepted: May 7, 2019. Pre-published: May 9, 2019.
doi:10.3324/haematol.2018.208637
Check the online version for the most updated information on this article, online supplements, and information on authorship & disclosures: www.haematologica.org/content/105/2/398
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