Addition of lomustine to idarubicin and cytarabine improves the outcome of elderly patients with de novo acute myeloid leukemia: a report from the GOELAMS
| Autor: | Arnaud Pigneux, Josy Reiffers, Mathilde Hunault-Berger, Chantal Himberlin, Severine Lissandre, Norbert Ifrah, Nathalie Fegueux, Bruno Lioure, Christian Berthou, François Dreyfus, Martine Escoffre-Barbe, Noel Milpied, Jean-Yves Cahn, Marie-Christine Béné, Mathieu Sauvezie, Christian Recher, Francis Witz, Jean-Luc Harousseau, Eric Jourdan, Isabelle Luquet |
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| Přispěvatelé: | Service d'Hématologie [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Service d'hématologie [Hôpital Edouard Herriot - HCL], Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Relations Hôte-Environnement (RHEM), Université Henri Poincaré - Nancy 1 (UHP), Laboratoire d'hématologie, Centre Hospitalier Universitaire de Reims (CHU Reims), Service des maladies du sang, Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM), Service d'onco-hématologie, CHU Strasbourg-Hôpital de Hautepierre [Strasbourg], Service d'hématologie clinique, Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou, Immunologie et Pathologie (EA2216), Université de Brest (UBO)-IFR148, Service d'hématologie [Tours], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours)-Hôpital Bretonneau, Service d'hématologie et oncologie médicale, Université Montpellier 1 (UM1)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Lapeyronie-Université de Montpellier (UM), TheREx, Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications, Grenoble - UMR 5525 (TIMC-IMAG), VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF)-Hematology, Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-CHU Grenoble, Service d'hématologie, Centre Hospitalier Saint Jean de Perpignan, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Validation et identification de nouvelles cibles en oncologie (VINCO), Institut Bergonié [Bordeaux], UNICANCER-UNICANCER-Université Bordeaux Segalen - Bordeaux 2-Institut National de la Santé et de la Recherche Médicale (INSERM), Université Bordeaux Segalen - Bordeaux 2, Haematology, CHU Bordeaux [Bordeaux], Service d'hématologie clinique [Avicenne], Université Paris 13 (UP13)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Avicenne [AP-HP], Hôpital Lapeyronie-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Université Montpellier 1 (UM1)-Université de Montpellier (UM), Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Bergonié [Bordeaux], UNICANCER-UNICANCER-Université Bordeaux Segalen - Bordeaux 2, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris 13 (UP13)-Hôpital Avicenne [AP-HP], Université de Rennes (UR)-Hôpital Pontchaillou, Université Joseph Fourier - Grenoble 1 (UJF)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Hematology |
| Rok vydání: | 2010 |
| Předmět: |
Male
Cancer Research MESH: Remission Induction MESH: Lomustine Gastroenterology Cohort Studies chemistry.chemical_compound 0302 clinical medicine MESH: Aged 80 and over Lomustine Antineoplastic Combined Chemotherapy Protocols Medicine MESH: Cytarabine Multicenter Studies as Topic MESH: Cohort Studies MESH: Treatment Outcome Randomized Controlled Trials as Topic MESH: Aged Aged 80 and over MESH: Middle Aged Remission Induction Cytarabine Myeloid leukemia Middle Aged Nitrogen mustard 3. Good health Survival Rate MESH: Antineoplastic Combined Chemotherapy Protocols Leukemia Myeloid Acute Treatment Outcome Oncology 030220 oncology & carcinogenesis Female MESH: Leukemia Myeloid Acute medicine.drug medicine.medical_specialty Anthracycline MESH: Survival Rate medicine.drug_class [SDV.CAN]Life Sciences [q-bio]/Cancer Antimetabolite 03 medical and health sciences Internal medicine Idarubicin Humans Aged Retrospective Studies MESH: Humans business.industry MESH: Idarubicin Induction chemotherapy MESH: Retrospective Studies MESH: Male Surgery MESH: Randomized Controlled Trials as Topic chemistry MESH: Multicenter Studies as Topic business MESH: Female 030215 immunology |
| Zdroj: | Journal of Clinical Oncology Journal of Clinical Oncology, American Society of Clinical Oncology, 2010, 28 (18), pp.3028-34. ⟨10.1200/JCO.2009.26.4648⟩ Journal of Clinical Oncology, 2010, 28 (18), pp.3028-34. ⟨10.1200/JCO.2009.26.4648⟩ |
| ISSN: | 1527-7755 0732-183X |
| DOI: | 10.1200/JCO.2009.26.4648⟩ |
| Popis: | Purpose No significant improvement in treatment outcome has been seen in elderly patients with acute myeloid leukemia (AML) over the past 20 years. This retrospective analysis investigated the prognostic factors for complete remission (CR) and survival in older patients with AML. Patients and Methods The study involved 847 patients older than 60 years enrolled onto three trials carried out in France between 1995 and 2005. Induction therapy consisted of idarubicin (8 mg/m2, days 1 through 5) and cytarabine (100 mg/m2, days 1 through 7; group I, 339 patients) or the same drugs plus lomustine (200 mg/m2 orally on day 1; group II, 508 patients). Consolidation therapy consisted of anthracycline and cytarabine courses at lower doses, preceded or not by a first course of intermediate-dose cytarabine. Results The rate of CR was significantly higher in patients in group II compared with group I (68% v 58%; P = .002). The rate of toxic death was similar in the two groups. In multivariate analysis, two prognostic factors were linked to CR: nonadverse cytogenetic (P < .003) and addition of lomustine to induction chemotherapy (P = .002). Median overall survival was significantly improved in patients treated with lomustine (median and SE, 12.7 ± 2.2 months v 8.7 ± 2.7 months; P = .004). In multivariate analysis, five prognostic factors positively affected overall survival: addition of lomustine (P = .002), age ≤ 69 years (P < .001), Eastern Cooperative Oncology Group performance status lower than 2 (P = .002), French-American-British subgroup 1/2 (P = .02), and nonadverse cytogenetic (P < .001). Conclusion Lomustine improves the rate of CR and survival in elderly patients with de novo AML when added to standard induction therapy. |
| Databáze: | OpenAIRE |
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