Contributions
Type: Publication Only
Background
Acute myeloid leukemia (AML) is common disease in people aged > 70 years. While the best management of AML is based mainly on intensive chemotherapy (CT) in younger patients, are still remains a matter of controversies in the elderly. In elderly AML patients, intensive CT is often poorly tolerated and gives scanty results.
Aims
The aim of this study was to identify the patients with AML not eligible for CT and who could be suitable only for supportive care.
Methods
This single-center study involved 68 patients aged > 70 years (range 71-85) with nonpromyelocytic AML during follow-up of 5 years. Patients were treated by three type of therapeutic regimen with various intensity: CT (induction therapy with daunorubicin 30 mg/m2 on day 1 and 3 and cytarabine 100 mg/m2 given for 5 days; or mitoxantrone 10 mg/m2 and etopozide 100 mg/m2 given for 5 days), paliative therapy (Hydroxiurea, Etoposide or 6-mercaptopurine per os) and supportive therapy (transfusions). Comorbidities were evaluated by using the hematopoetic cell transplantation-specific comorbidity index (HCT-CI). Performance status (PS) was evaluated by Eastern Cooperative Oncology Group (ECOG), ranged 0-4. Cytogenetic risk group was assessed by recomandation of Europian LeukemiaNet (ELN). The following parameters were estimated as risk factors for treatmement with CT: age > 75 years, leukocytopenia (white blood count < 4 x 109/L), thrombocytopenia (platelet count < 50 x 109/L), higher absolute peripheral blasts (> 5 x 109/L), ECOC PS (<2 vs ≥ 2), ELN cytogenetic risk group, and HCT-CI (<3 vs ≥ 3). Risk factors were identified using the univariate and multivariate analysis.
Results
In this group of patients, 16 pts treated with CT, 24 pts treated with palliative and 28 pts with supportive therapy. In group of patients treated with CT, univariate analysis showed that the following risk factors were significant for OS: leukocytopenia (p=0.039), thrombocytopenia (p=0.043), higher absolute peripheral blasts (p=0.002), ECOG PS ≥ 2 (p<0.001) and HCT-CI ≥ 3 (p< 0.001). Multivariate analysis indicated HCT-CI ≥ 3 as the most important risk factor for poor OS of patients treated with CT: p<0.001, relative risk (RR)=3.689; 95% confidental interval (CI)=1.817-7.489. Patients with leukcytopenia and HCT-CI ≥ 3 were separated in single group and in this group (17 pts) most benefit for OS had patients treated only with supportive therapy: p=0.043, RR=0.382, CI=0.131-1.115.
Summary
Elderly AML patients with cytopenia and comorbidities are not suitable for intensive CT. In these patients supportive care need to be concidere as a choise of therapy because the intensive CT has a poor influence on its OS.
Keyword(s): Acute myeloid leukemia, Elderly, Risk factor, Treatment
Session topic: Publication Only
Type: Publication Only
Background
Acute myeloid leukemia (AML) is common disease in people aged > 70 years. While the best management of AML is based mainly on intensive chemotherapy (CT) in younger patients, are still remains a matter of controversies in the elderly. In elderly AML patients, intensive CT is often poorly tolerated and gives scanty results.
Aims
The aim of this study was to identify the patients with AML not eligible for CT and who could be suitable only for supportive care.
Methods
This single-center study involved 68 patients aged > 70 years (range 71-85) with nonpromyelocytic AML during follow-up of 5 years. Patients were treated by three type of therapeutic regimen with various intensity: CT (induction therapy with daunorubicin 30 mg/m2 on day 1 and 3 and cytarabine 100 mg/m2 given for 5 days; or mitoxantrone 10 mg/m2 and etopozide 100 mg/m2 given for 5 days), paliative therapy (Hydroxiurea, Etoposide or 6-mercaptopurine per os) and supportive therapy (transfusions). Comorbidities were evaluated by using the hematopoetic cell transplantation-specific comorbidity index (HCT-CI). Performance status (PS) was evaluated by Eastern Cooperative Oncology Group (ECOG), ranged 0-4. Cytogenetic risk group was assessed by recomandation of Europian LeukemiaNet (ELN). The following parameters were estimated as risk factors for treatmement with CT: age > 75 years, leukocytopenia (white blood count < 4 x 109/L), thrombocytopenia (platelet count < 50 x 109/L), higher absolute peripheral blasts (> 5 x 109/L), ECOC PS (<2 vs ≥ 2), ELN cytogenetic risk group, and HCT-CI (<3 vs ≥ 3). Risk factors were identified using the univariate and multivariate analysis.
Results
In this group of patients, 16 pts treated with CT, 24 pts treated with palliative and 28 pts with supportive therapy. In group of patients treated with CT, univariate analysis showed that the following risk factors were significant for OS: leukocytopenia (p=0.039), thrombocytopenia (p=0.043), higher absolute peripheral blasts (p=0.002), ECOG PS ≥ 2 (p<0.001) and HCT-CI ≥ 3 (p< 0.001). Multivariate analysis indicated HCT-CI ≥ 3 as the most important risk factor for poor OS of patients treated with CT: p<0.001, relative risk (RR)=3.689; 95% confidental interval (CI)=1.817-7.489. Patients with leukcytopenia and HCT-CI ≥ 3 were separated in single group and in this group (17 pts) most benefit for OS had patients treated only with supportive therapy: p=0.043, RR=0.382, CI=0.131-1.115.
Summary
Elderly AML patients with cytopenia and comorbidities are not suitable for intensive CT. In these patients supportive care need to be concidere as a choise of therapy because the intensive CT has a poor influence on its OS.
Keyword(s): Acute myeloid leukemia, Elderly, Risk factor, Treatment
Session topic: Publication Only