Cladribine Combined with Low-Dose Cytarabine as Frontline Treatment for Unfit Elderly Acute Myeloid Leukemia Patients: Results from a Prospective Multicenter Study of Polish Adult Leukemia Group (PALG).

Autor:	Budziszewska BK; Department of Hematology, Institute of Hematology and Transfusion Medicine, 02-776 Warsaw, Poland.; Centre of Postgraduate Medical Education, 01-813 Warsaw, Poland., Salomon-Perzyński A; Department of Hematology, Institute of Hematology and Transfusion Medicine, 02-776 Warsaw, Poland., Pruszczyk K; Department of Hematology, Institute of Hematology and Transfusion Medicine, 02-776 Warsaw, Poland., Barankiewicz J; Department of Hematology, Institute of Hematology and Transfusion Medicine, 02-776 Warsaw, Poland., Pluta A; Department of Hematology, Medical University of Lodz, 93-513 Lodz, Poland., Helbig G; Department of Hematology and Bone Marrow Transplantation, School of Medicine in Katowice, Medical University of Silesia, 40-032 Katowice, Poland., Janowska A; Department of Hematology, Medical University of Lodz, 93-513 Lodz, Poland., Kuydowicz M; Department of Hematology, Medical University of Lodz, 93-513 Lodz, Poland., Bołkun Ł; Department of Hematology, Medical University of Bialystok, 15-276 Bialystok, Poland., Piszcz J; Department of Hematology, Medical University of Bialystok, 15-276 Bialystok, Poland., Patkowska E; Department of Hematology, Institute of Hematology and Transfusion Medicine, 02-776 Warsaw, Poland., Wątek M; Department of Hematology, Institute of Hematology and Transfusion Medicine, 02-776 Warsaw, Poland., Małecki P; Department of Hematology and Cancer Prevention, Faculty of Health Sciences, Medical University of Silesia, 40-055 Katowice, Poland., Kościołek-Zgódka S; Center of Oncology, Hematology Department, 25-734 Kielce, Poland., Cichocka E; Hematology Department, Nicolaus Copernicus Hospital, 87-100 Torun, Poland., Charliński G; Warmian-Masurian Cancer Center of The Ministry of The Interior and Administration's Hospital, Department of Hematology, 10-228 Olsztyn, Poland., Irga-Staniukiewicz A; Department of Hematology and Transplantology, Medical University of Gdansk, 80-952 Gdansk, Poland., Zaucha JM; Department of Hematology and Transplantology, Medical University of Gdansk, 80-952 Gdansk, Poland., Piekarska A; Department of Hematology and Transplantology, Medical University of Gdansk, 80-952 Gdansk, Poland., Gromek T; Department of Hematooncology and Bone Marrow Transplantation, Medical University of Lublin, 20-081 Lublin, Poland., Hus M; Department of Hematooncology and Bone Marrow Transplantation, Medical University of Lublin, 20-081 Lublin, Poland., Wójcik K; Hematology Department, Rydygier Memorial Hospital, 31-826 Krakow, Poland., Raźny M; Hematology Department, Rydygier Memorial Hospital, 31-826 Krakow, Poland., Sędzimirska M; Lower Silesian Centrum for Cellular Transplantation, 53-439 Wroclaw, Poland., Puła B; Department of Hematology, Institute of Hematology and Transfusion Medicine, 02-776 Warsaw, Poland., Giebel S; Department of Bone Marrow Transplantation and Onco-Hematology, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, 44-102 Gliwice, Poland., Grosicki S; Department of Hematology and Cancer Prevention, Faculty of Health Sciences, Medical University of Silesia, 40-055 Katowice, Poland., Wierzbowska A; Department of Hematology, Medical University of Lodz, 93-513 Lodz, Poland., Lech-Marańda E; Department of Hematology, Institute of Hematology and Transfusion Medicine, 02-776 Warsaw, Poland.; Centre of Postgraduate Medical Education, 01-813 Warsaw, Poland.
Jazyk:	angličtina
Zdroj:	Cancers [Cancers (Basel)] 2021 Aug 20; Vol. 13 (16). Date of Electronic Publication: 2021 Aug 20.
DOI:	10.3390/cancers13164189
Abstrakt:	Acute myeloid leukemia (AML) in older unfit patients is a therapeutic challenge for clinical hematologists. We evaluated the efficacy and safety of a novel low-intensity regimen consisting of low-dose cytarabine and cladribine (LD-AC+cladribine) in first-line treatment of elderly (≥60 years) AML patients not eligible for intensive chemotherapy (IC) who had either the Eastern Cooperative Oncology Group performance status (ECOG PS) ≥2 or the hematopoietic cell transplantation comorbidity index (HCT-CI) score ≥3. The induction phase included two cycles of LD-AC+cladribine. Patients who achieved at least partial remission (PR) received maintenance treatment with LD-AC alone. Overall, 117 patients with a median age of 70 years were enrolled. Adverse cytogenetics, ECOG PS ≥2 and HCT-CI score ≥3 was observed in 43.5%, 60%, and 58% of patients, respectively. The response rate (≥PR) was 54% (complete remission [CR], 32%; CR with incomplete hematologic recovery [CRi], 5%). A median overall survival (OS) was 21 and 8.8 months in CR/CRi and PR group, respectively. Advanced age (≥75 years) and adverse cytogenetics had a negative impact on OS. The 56-day mortality rate was 20.5%. In conclusion, LD-AC+cladribine is a beneficial therapeutic option with a predictable safety profile in elderly AML patients not eligible for IC.
Databáze:	MEDLINE
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