Time-dependent decision analysis: Stable disease in azacitidine (AZA)-treated patients (pts) with higher-risk MDS.

Gore, S.D.; Fenaux, Pierre; Bennett, John M.; Silverman, L.R.; Seymour, John F.; Hellström‐Lindberg, Eva; Swern, Arlene S.; Beach, C. L.; List, Alan F.

doi:10.1200/jco.2010.28.15_suppl.6503

Cited by 9 publications

(8 citation statements)

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“…However, we observed that this was not reflected in the OS rates, as shown by the trend toward superior median OS for patients who received HMA‐based therapy versus those who received IC . In this respect, the OS of patients receiving HMA therapy may not be predicted by the type of response as much as by the evidence of any degree of improvement (CR, partial response, or hematologic improvement), including stable disease . Furthermore, retrospective data have suggested the possible superiority of HMAs over traditional cytotoxic agents in patients with adverse‐risk cytogenetics …”

Section: Discussionmentioning

confidence: 84%

Characteristics and outcomes of older patients with secondary acute myeloid leukemia according to treatment approach

Boddu

Kantarjian

Ravandi

et al. 2017

Cancer

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BACKGROUND Developing newer strategies to improve outcomes in older patients with secondary AML is a critical unmet need. Establishing baseline metrics from which to evaluate newer approaches is important. METHODS Secondary AML was defined by one or more of the following: history of antecedent hematological disorder; the diagnosis of therapy related AML; AML with karyotype abnormalities characteristic of MDS. Newly diagnosed secondary AML (s-AML) patients aged 60–75 years were grouped into 5 treatment cohorts: 1) high/intermediate intensity chemotherapy (IC), 2) hypomethylating agent (HMA)/HMA combinations, 3) low dose Ara-c combinations (LDAC), 4) CPX-351, 5) investigational (INV). 931 patients met the criteria of age and s-AML. RESULTS Complete remission rates were statistically lower in the HMA (36%) when compared with IC (46%), CPX-351 (45%) and LDAC (43%). Patients receiving less intensive regimens [HMA and LDAC based, combined] had superior OS compared with IC-based regimens (6.9m vs. 5.4; P=0.048). Only 4.3% of IC patients proceeded to transplant as compared with 10.3% of patients on lower intensity regimens (p=0.001). There was no difference in median survival in patients treated with CPX-351 compared with conventional lower-intensity approaches (p=0.75). Age >70yrs, adverse karyotype, and prior AHD were associated with a decreased OS on multivariate analysis. CONCLUSIONS Lower-intensity approaches are associated with lower early mortality and improved OS when compared with intensive regimens. Overall survival is poor with currently available therapies, with average OS of 6 months (across regimens, 5.4–7.6 mo). Unsatisfactory outcomes using other investigational agents (INV) underscores the need for more effective therapies.

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Section: Discussionmentioning

confidence: 84%

Characteristics and outcomes of older patients with secondary acute myeloid leukemia according to treatment approach

Boddu

Kantarjian

Ravandi

et al. 2017

Cancer

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“…In other series, however, the therapy was usually not stopped unless a CR was achieved [6,7,[11][12][13][14]. Gore et al [16], reported of delayed responses that occurred beyond 9 months in patients who continued to use Aza-C. This may explain the gap between the median times to AML progression in our patients and that of the literature (10 vs. 15 and 21 months).…”

Section: Discussionmentioning

confidence: 99%

Azacitidine has limited activity in ‘real life’ patients with MDS and AML: a single centre experience

Ozbalak

Çetiner

Beköz

et al. 2011

Hematological Oncology

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Myelodysplastic syndrome (MDS) represents a heterogeneous group of potentially malignant diseases of bone-marrow stem cells. Acute myelogenous leukaemia (AML) is an inevitable outcome for many patients with MDS. Azacitidine has been reported to result in comparably higher response rates and improved survival than other treatment strategies. In this retrospective study, we report the results on 25 'real life' patients with MDS, CMML or AML treated with azacitidine between 2005 and 2009. All patients fulfilled the World Health Organization criteria for MDS and AML. No eligibility criteria other than diagnosis were considered. Complete response (CR) rate was observed in three of the 25 'real life' patients (12%) with a median duration of CR of 5 months (4-6 months). Seven patients (28%) had mono- or bi-lineage haematologic improvement and 15 patients (60%) showed neither morphologic nor haematologic response. Among 17 non-AML patients, the median time from onset of Aza-C treatment to AML transformation was 10 months (4-15 months). Overall death rate was 72%. All of the eight AML patients died. The death rate under Aza-C among non-AML patients was 59%. Unlike the results of the clinical trials, our data show that Aza-C has a limited activity in 'real-life' patients with MDS and AML. It is obvious that Aza-C can induce complete or partial responses in a considerable number of MDS patients but responses are usually not durable as we observed in our patients.

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“…Such analyses have suggested that any response is associated with better OS than no response and that type of response (CR, CRp, PR, HI) is not so associated26 or that OS is similar as long as stable disease is obtained 27. Thus the need for CR to obtain longer OS, seen with traditional anti-AML therapy is unlikely to apply with azacitidine and decitabine; the same may apply with regard to survival beyond 2 years 28.…”

Section: Prediction Of Response To Azacitidine or Decitabinementioning

confidence: 99%

Therapeutic Options for Patients Who Are Not Eligible for Intensive Chemotherapy

Estey¹

2013

Mediterr J Hematol Infect Dis

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Although “less intense” therapies are finding more use in AML, the principal problem in AML remains lack of efficacy rather than toxicity. Hence less intense therapies are of little use if they are not more effective as well as less toxic than standard therapies. Assignment of patients to less intense therapies should be based on other factors in addition to age. Azacitidine and decitabine, the most commonly used less intense therapies in AML very probably produce better OS than best “supportive care” or “low-dose” ara-C. However improvement is relatively small when compared to expected life expectancy in the absence of disease. Accordingly, while azacitidine or decitabine should be considered the standards against which newer therapies are compared, continued investigation of potentially more effective therapies needs to continue. Better means for evaluating the large number of these therapies (and their combinations) are also needed.

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Time-dependent decision analysis: Stable disease in azacitidine (AZA)-treated patients (pts) with higher-risk MDS.

Cited by 9 publications

References 0 publications

Characteristics and outcomes of older patients with secondary acute myeloid leukemia according to treatment approach

Characteristics and outcomes of older patients with secondary acute myeloid leukemia according to treatment approach

Azacitidine has limited activity in ‘real life’ patients with MDS and AML: a single centre experience

Therapeutic Options for Patients Who Are Not Eligible for Intensive Chemotherapy

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