Ten-year outcome of patients with acute myeloid leukemia not treated with allogeneic transplantation in first complete remission

Abstract

Key Points• Only 16.6% of patients aged ,60 years and 2.4% aged $60 years treated with chemotherapy are disease-free at 10 years after diagnosis.• Ten-year disease-free survivors were mostly diagnosed with corebinding factor AML with t(8;21) or inv(16), or had a normal karyotype.The probability that adult patients with de novo acute myeloid leukemia (AML) receiving intensive chemotherapy in the absence of allogeneic hematopoietic stem cell transplantation (Allo-HCT) in first complete remission (CR1) will be disease-free at 10 years after diagnosis, of those aged $60 years were alive and disease-free. This disease-free AML group consisted predominantly of patients with core-binding factor AML with t(8;21)(q22;q22) or inv(16)(p13q22)/t(16;16)(p13;q22) and those with a normal karyotype. Occurrences of AML beyond 10 years were infrequent and associated with cytogenetic findings different from those at diagnosis. These data provide evidence that the frequency of long-term cure of AML is low among younger and especially older patients in the absence of Allo-HCT in CR1.In older patients not appropriate for Allo-HCT, these data provide further justification for early use of alternative treatments outside of intensive chemotherapy.

Enasidenib, an inhibitor of mutant IDH2 proteins, induces durable remissions in older patients with newly diagnosed acute myeloid leukemia

“…Median overall survival (OS) for older AML patients who did not receive therapy was 2 months, and for those who received available lower-intensity strategies was~6 months [2][3][4]. Older patients treated without an allogeneic stem cell transplantation had a 10-year OS of only 2.4% [5].…”

How we use venetoclax with hypomethylating agents for the treatment of newly diagnosed patients with acute myeloid leukemia

“…Acute myeloid leukemia (AML) most commonly affects older adults, with a median age at diagnosis of 68 [1]. Outcomes are poor for patients 60 years and older who do not receive stem cell transplantation, with only 2.4% remaining alive and disease-free 10 years after diagnosis [2]. These poor outcomes are due to patient-related factors, such as increased comorbidities [3], and disease-related factors, particularly the higher incidence of adverse-risk cytogenetic abnormalities in older AML patients [4].…”

Optimizing survival outcomes with post‐remission therapy in acute myeloid leukemia

“…The 5‐year overall survival (OS) rate ranges from 40% to 50% in patients aged <60 years and from 20% to 30% in patients aged >60 to 70 years who receive high‐intensity chemotherapy regimens . Furthermore, in a study of 2551 patients with AML who did not undergo stem cell transplant, the 10‐year progression‐free survival (PFS) rate was 2.4% among patients aged ≥60 years …”