High dose cytarabine, mitoxantrone and l-asparaginase (HAMA) salvage for relapsed or refractory acute myeloid leukemia (AML) in the elderly

Abstract

Acute myeloid leukemia (AML) is an aggressive malignancy that affects older patients. The role of salvage therapy in the elderly is controversial and there is little data on efficacy. Outcomes for 94 relapsed or refractory AML patients who received salvage HAMA therapy were analyzed. Of the 94 patients 66 were ≥60, including 26 patients ≥70, and 28 were <60 years old. Early mortality (30-day) was 14% (4%<60, 18%≥60 years old). Overall, 27% of patients died during hospitalization or were discharged to hospice (11%<60, 33%≥60 years old). CR/CRi was achieved in 41% of patients (61%<60, 33%≥60 years old). Median survival was 6.1 months (15.7<60, 5.2≥60). Patients ≥60 who achieved a CR/CRi had a median survival of 11.7 months. At 12 months 56% of patients <60 were alive versus 24% of patients ≥60. At 24 months these numbers fell to 40% and 2% respectively. In those <60 years old, 50% went on to allogeneic hematopoietic stem cell transplant (HSCT) whereas 14% of patients in the ≥60 cohort did so. In conclusion, HAMA salvage therapy results in a 33% response rate in patients ≥60 years old with acceptable toxicity.

Keywords: Acute myeloid leukemia; Elderly patients; High dose cytarabine; Salvage therapy.

Figure 1

Schema of trial. Patients with relapsed or refractory AML treated at our institution with HAMA salvage therapy were identified and eligibility assessed.

Figure 2

Survival rates for the entire cohort. Kaplan-Meier curves for all patients treated with HAMA are shown.

Figure 3

Survival of cohort by cytogenetic risk category. Kaplan-Meier curves for patients are shown for patients in the good, intermediate and poor cytogenetic risk categories. P value was determined by Log-Rank test.

Figure 4

Survival of cohort by duration of CR1. Kaplan-Meier curves for patients are shown for patients with CR1>1 and <1 year. P value was determined by Log-Rank test.

Figure 5

Survival of cohort by duration of CR1 in both the younger and older cohorts. A) Kaplan-Meier curves for patients <60 years old are shown divided by length of CR1. B) Kaplan-Meier curves for patients ≥60 years old are shown divided by length of CR1. P values were determined by Log-Rank test.