Role of induction and consolidation chemotherapy in elderly acute myeloid leukemia patients

Abstract

The present study sought to elucidate the role of induction and consolidation therapy in elderly patients. We retrospectively collected data of 477 patients who were aged over 60 years at the time of acute myeloid leukemia (AML) diagnosis. The median overall survival (OS) was 339 days in the induction group (n = 266) and 86 days in the best supportive care group (n = 211) (P < 0.001). In the induction group, the complete remission (CR) rate was 58.3 %, and treatment-related death was 15.4 %. Successful induction was related to good performance [Eastern Cooperative Oncology Group (ECOG <2)] [hazard ratio (HR) 3.215; P = 0.002]. Mortality correlated with failure to achieve CR (HR 4.059; P < 0.001) and poor performance status (ECOG >2) (HR 2.731; P = 0.035). In CR patients, poor karyotype and absence of consolidation (HR 2.313; P = 0.003) correlated with mortality. More than one cycle of consolidation was associated with better OS (P < 0.001). Lack of salvage therapy was associated with mortality in patients who did not achieve CR (HR 3.223; P = 0.005). Intensive induction in patients with good performance and >1 cycle of consolidation after CR may be the best strategy for improving OS in elderly AML patients.

A multicenter, retrospective analysis of elderly patients with acute myeloid leukemia who were treated with decitabine

“…The decision of the front-line treatment for elderly AML patients is a challenging issue. To evaluate the efficacy of decitabine compared to BSC or intensive chemotherapy in elderly AML patients, we compared our data to the data of a study by Kim et al [ 17 ], in which retrospective analyses of 477 Korean elderly AML patients who were treated with either BSC or intensive chemotherapy were undertaken (Table 3 ). In terms of patient characteristics, our cohort is consisted of older patients, and the proportion of poor performance/cytogenetics was higher in our cohort.…”

American Society of Hematology 2020 guidelines for treating newly diagnosed acute myeloid leukemia in older adults

“…62,64,[85][86][87][88][89][90][91][92][93][94][95][96][97] Eighteen additional studies were reviewed but excluded from the meta-analyses due to lack of data on the outcomes prioritized by the expert panel. [98][99][100][101][102][103][104][105][106][107][108][109][110][111][112][113][114][115][116] Given the challenges in randomizing patients to intensive or less-intensive treatments, most of the included studies were observational. 62,85,86,93,95,96 Two were randomized clinical trials (RCTs).…”

“…For the comparison between intensive antileukemic therapy and best supportive care, low-quality evidence suggests that the hazard of death for patients who receive intensive antileukemic therapy may be 0.36 times that of the patients who receive best supportive care, over time (HR, 0.36; 95% confidence interval, 0.26-0.50). 62,64,[85][86][87][88][89][90][91][92][93] Low-quality evidence suggests that the risk of death for patients who receive intensive antileukemic therapy may be lower than that of the patients who receive best supportive care at 30 days, 62,88,89,92,93 at 6 months, 86,91 and at 1 year 64,86,87,[90][91][92] The studies not included in the meta-analyses [98][99][100][101][102][103][104][105][106][107][108][109][110][111][112][113][114][115] reported outcomes similar to those described herein.…”

“…139 In 1 observational study, researchers reported the outcomes for 48 patients who received 1 cycle of consolidation plus 1 cycle of postremission therapy with gemtuzumab ozogamicin or 1 cycle of consolidation therapy plus autologous HSCT (auto-HSCT; evidence profile 2). 140 In 4 studies, 3 RCTs with 258 participants 70,141,142 and 1 observational study with 126 patients, 106 researchers compared mortality and time to recurrence between patients who received 2 cycles of consolidation therapy and patients who received 1 cycle (evidence profile 3).…”

Valproic acid enhances the antileukemic effect of cytarabine by triggering cell apoptosis

“…AML predominantly affects elderly adults, with a median age at diagnosis of 68 years (4). Unfortunately, most elderly patients cannot tolerate the side-effects of intensive chemotherapy and tend to be more resistant to standard chemotherapy drugs: only 30-50% achieve complete remission, and <10% are long-term survivors (4,5). Thus, the outcome for elderly patients is disappointing, and is markedly inferior to that obtained for younger patients.…”