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. 2010 Nov 25;116(22):4422-9.
doi: 10.1182/blood-2010-03-276485. Epub 2010 Jul 28.

Intensive chemotherapy does not benefit most older patients (age 70 years or older) with acute myeloid leukemia

Hagop Kantarjian  1 , Farhad Ravandi, Susan O'Brien, Jorge Cortes, Stefan Faderl, Guillermo Garcia-Manero, Elias Jabbour, William Wierda, Tapan Kadia, Sherry Pierce, Jianqin Shan, Michael Keating, Emil J Freireich
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Intensive chemotherapy does not benefit most older patients (age 70 years or older) with acute myeloid leukemia

Hagop Kantarjian et al. Blood. .

Abstract

Patients ≥ 70 years of age with acute myeloid leukemia (AML) have a poor prognosis. Recent studies suggested that intensive AML-type therapy is tolerated and may benefit most. We analyzed 446 patients ≥ 70 years of age with AML (≥ 20% blasts) treated with cytarabine-based intensive chemotherapy between 1990 and 2008 to identify risk groups for high induction (8-week) mortality. Excluding patients with favorable karyotypes, the overall complete response rate was 45%, 4-week mortality was 26%, and 8-week mortality was 36%. The median survival was 4.6 months, and the 1-year survival rate was 28%. Survival was similar among patients treated before 2000 and since 2000. A multivariate analysis of prognostic factors for 8-week mortality identified the following to be independently adverse: age ≥ 80 years, complex karyotypes, (≥ 3 abnormalities), poor performance (2-4 Eastern Cooperative Oncology Group), and elevated creatinine > 1.3 mg/dL. Patients with none (28%), 1 (40%), 2 (23%), or ≥ 3 factors (9%) had estimated 8-week mortality rates of 16%, 31%, 55%, and 71% respectively. The 8-week mortality model also predicted for differences in complete response and survival rates. In summary, the prognosis of most patients (72%) ≥ 70 years of age with AML is poor with intensive chemotherapy (8-week mortality ≥ 30%; median survival < 6 months).

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Figures

Figure 1
Figure 1
Survival and CR duration of the 16 elderly patients with CBF leukemias.
Figure 2
Figure 2
CR duration and survival among patients achieving CR.
Figure 3
Figure 3
Survival of 430 elderly patients with AML, excluding CBF leukemias, by year of therapy.
Figure 4
Figure 4
Survival of 430 elderly patients with AML by number of independent risk factors for 8-week mortality.
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References

    1. Lowenberg B, Downing JR, Burnett A. Acute myeloid leukemia. N Engl J Med. 1999;341(14):1051–1062. - PubMed
    1. Mayer RJ, Davis RB, Schiffer CA, et al. Intensive post remission chemotherapy in adults with acute myeloid leukemia. N Engl J Med. 1994;331(14):896–903. - PubMed
    1. Bishop JF, Matthews JP, Young GAR, Bradstock K, Lowenthal R on behalf of the ALSG. Intensified induction chemotherapy with high dose cytarabine and etoposide for acute myeloid leukemia: a review and updated results of the Australian Leukemia Study Group. Leuk Lymphoma. 1998;28(3-4):315–327. - PubMed
    1. Grimwade D, Walker H, Oliver F, et al. The importance of diagnostic cytogenetics on outcome in AML: analysis of 1612 patients entered into the MRC AML 10 trial. Blood. 1998;92(7):2322–2333. - PubMed
    1. Wahlin A, Hornsten P, Jonsson H. Remission rate and survival in acute myeloid leukemia: impact of selection and chemotherapy. Eur J Haematol. 1991;46(4):240–247. - PubMed

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