Current treatment preferences in acute myeloid leukemia: a survey in Brazil

Abstract

Introduction : Most adults with acute myeloid leukemia (AML) will eventually relapse from their disease. The combination of 7-day cytarabine and an anthracycline on days 1–3 (the so called “7 + 3” regimen) can be considered standard of care of younger patients with AML. However, the treatment of the elderly ineligible for intensive chemotherapy remains a challenge. Low-dose of subcutaneous cytarabine or hypomethylating agents (HMA) have been studied this group. There are no studies investigating physician practice variation in treating AML in Brazil. Methods : We developed a survey with ten questions in order to explore the approach to AML in Brazil. Results : The sample size comprised 100 hematologists. Most reported regular (63%) or occasional (29%) treatment of AML patients. Karyotype analysis and polymerase chain reaction were available in 88% and 71% of institutions, respectively. Next generation sequencing analysis was used in 7% of instituitions. Younger patients receive the “7 + 3” protocol with continuous infusion of cytarabine and anthracycline in 98% of cases. The preferred anthracycline is daunorubicin (64%), followed by idarubicin (34%). The most prescribed daunorubicin dose was 60 mg/m 2 (56%). Consolidation after CR with high cytarabine doses (HIDAC) was indicated by 84% of hematologists and 70% use 3 g/m 2 twice a day for 3 days. Elderly and unfit patients received HMA (47%) as the preferred treatment. Conclusion : We showed that the most prevalent AML treatments were according to current guidelines. There is room to improve on the availability of diagnostic tools and the capacity to perform bone marrow transplantation.

Patterns of undertreatment among patients with acute myeloid leukemia (AML): considerations for patients eligible for non-intensive chemotherapy (NIC)

“…It is possible that some physicians employ criteria intended to determine a patient's candidacy for IC to exclude them from NIC as well. According to a survey of 100 hematologists, 5% expressed a preference for using BSC only to treat patients who were either elderly or not candidates for IC (Portugal and Nucci 2019). Percival et al (2019) reported the lowest rate of NAAT (10%).…”

Improving awareness of several combination therapies for acute myeloid leukemia among oncology and hematology team members in Colorado, USA

“…There has been a survey of 2,621 hematologists in Brazil conducted between March and May of 2018. 19 The incorporation of emerging therapies for AML was highly expected in that study, with more than 60% of survey respondents having expected midostaurin and more than half doing so for GO. 19 …”

“…AML is a relatively common condition that affects predominantly older adults. 2 , 19 Once diagnosed, only one in ten older adults will live longer than 5 years. 2 , 7 Moreover, one in three elderly patients does not receive active treatment as these patients are often diagnosed with various comorbidities making them ineligible for intensive chemotherapy.…”

“…2 , 7 Emerging combination therapies for AML targeting these disadvantaged populations may improve the chances of survival and bring new hope. 2 , 7 , 19 Additionally, new combination therapies may offer other important benefits, such as complete remission and improved event-free survival. 2 , 7 , 19 As such, these emerging treatment approaches may open up new opportunities for oncology and hematology teams worldwide.…”

“…2 , 7 , 19 Additionally, new combination therapies may offer other important benefits, such as complete remission and improved event-free survival. 2 , 7 , 19 As such, these emerging treatment approaches may open up new opportunities for oncology and hematology teams worldwide.…”