Post-remission therapy of adults aged 60 and older with acute myeloid leukemia in first complete remission: role of treatment intensity on the outcome

Autor: B. Bouchacourt, M. A. Hospital, C. Zemmour, J. Rey, E. d’Incan, A. Charbonnier, B. Mohty, C. Saillard, S. Bonnet, A. Collignon, V. Gelsi-Boyer, M. J. Mozziconacci, D. Blaise, N. Vey
Rok vydání: 2019
Předmět:
Male
medicine.medical_specialty
medicine.medical_treatment
Blood Component Transfusion
Hematopoietic stem cell transplantation
Kaplan-Meier Estimate
Transplantation
Autologous
Disease-Free Survival
03 medical and health sciences
0302 clinical medicine
Internal medicine
Antineoplastic Combined Chemotherapy Protocols
medicine
Humans
Aged
Retrospective Studies
Aged
80 and over
Chemotherapy
Hematology
business.industry
Daunorubicin
Remission Induction
Cytarabine
Hematopoietic Stem Cell Transplantation
Myeloid leukemia
Retrospective cohort study
General Medicine
Middle Aged
Allografts
Combined Modality Therapy
Consolidation Chemotherapy
Regimen
Leukemia
Myeloid
Acute
surgical procedures
operative
Platelet transfusion
Treatment Outcome
030220 oncology & carcinogenesis
Female
business
030215 immunology
medicine.drug
Follow-Up Studies
Zdroj: Annals of hematology. 99(4)
ISSN: 1432-0584
Popis: Although complete remission (CR) is achieved in 50 to 70% of older fit patients with acute myeloid leukemia (AML), consolidation therapy in this age group remains challenging. In this retrospective study, we aimed to compare outcome in elderly patients treated with different post-remission modalities, including allogenic and autologous hematopoietic stem cell transplantation (HSCT), intensive chemotherapy, and standard-dose chemotherapy (repeated 1 + 5 regimen). We collected data of 441 patients ≥ 60 years in first CR from a single institution. Median age was 67 years. Sixty-one (14%) patients received allo-HSCT, 51 (12%) auto-HSCT, 70 (16%) intensive chemotherapy with intermediate- or high-dose cytarabine (I/HDAC), and 190 (43%) 1 + 5 regimen. Median follow-up was 6.5 years. In multivariate analysis, allo-HSCT, cytogenetics, and PS had a significant impact on OS and LFS. In spite of a more favorable-risk profile, the patients who received I/HDAC had no significantly better LFS as compared with patients treated with 1 + 5 (median LFS 8.8 months vs 10.6 months, p = 0.96). In transplanted patients, median LFS was 13.3 months for auto-HSCT and 25.8 months for allo-HSCT. Pre-transplant chemotherapy with I/HDAC had no effect on the outcome. Toxicity was significantly increased for both transplanted and non-transplanted patients treated with I/HDAC, with more units of blood and platelet transfusion and more time spent in hospitalization, but no higher non-relapse mortality. This study shows that post-remission chemotherapy intensification is not associated with significantly better outcome as compared with standard-dose chemotherapy in elderly patients for whom, overall results remain disappointing.
Databáze: OpenAIRE
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