Department of Hematology
Contributions
Type: Publication Only
Background
Currently the hypomethylating agents (azacitidine, decitabine) are safe and effective alternative treatment for patients with acute myeloid leukemia (AML) that do not fit for intensive chemotherapy treatments. Several studies have been described the modification of the treatment regimen with hypomethylating agentes. We analyzed the effectiveness of decitabine in patients with acute leukemia not eligible for intensive therapy.
Aims
The objective of this study is to analyze the safety and efficacy of using decitabine in 10-day regimen.
Methods
We reviewed 11 patients with AML treated with DEC between June 2010 and January 2015. The schedule was DEC 20 mg/m2 x 10 days in induction therapy. Patients who achieved remission cytological (defined as <5% blasts in the bone marrow aspirate) received consolidation therapy with DEC 20 mg/m2 x 5 days until progression and the remaining patients received a re-induction before start consolidation therapy.
Results
36.4% were de novo AML 63.6% were secondary AML (2 myelofibrosis, 4 MDS and CMML 1). All patients were male with a median age of 82 years old (range 69-86) and 36.4% patients had cytogenetic abnormalities in diagnosis according to European Leukemia Net (ELN): 6 patients were favorable risk, intermediate risk 1 and 3 high-risk. 54.5% patients had> 30% blasts and 45.4% received treatment previously. 91% of patients had some comorbidities. A median of 6 cycles (range 1-10) were administered in total 57 cycles of decitabine. All patients had adverse effects during treatment, the most frequent febrile neutropenia (63%) and there was an early death (<8 weeks) associated with liver failure in a patient previously diagnosed. According to ELN, with induction in 10 days, we had a global response rate of 72.7% (2 CR with cytogenetic remission; 2 CR, 4 CR with incomplete hematologic recovery, 1 PR and 3 patients with refractory disease. Secondary AML, transfusion dependence and number of blasts> 30% at diagnosis, had no effect on treatment response induction. In our study 6 patients died because disease progression infection. Median follow-up of 340 days (range 148- 1506 days) with OS of 63% in 1-year and 45.5% during the follow up with a DFS of 45.5%.
Summary
In our experience, decitabine in 10-day regimen in elderly patients is safe and very effective, even in poor prognosis patients.
Keyword(s): AML, Decitabine, Elderly
Session topic: Publication Only
Type: Publication Only
Background
Currently the hypomethylating agents (azacitidine, decitabine) are safe and effective alternative treatment for patients with acute myeloid leukemia (AML) that do not fit for intensive chemotherapy treatments. Several studies have been described the modification of the treatment regimen with hypomethylating agentes. We analyzed the effectiveness of decitabine in patients with acute leukemia not eligible for intensive therapy.
Aims
The objective of this study is to analyze the safety and efficacy of using decitabine in 10-day regimen.
Methods
We reviewed 11 patients with AML treated with DEC between June 2010 and January 2015. The schedule was DEC 20 mg/m2 x 10 days in induction therapy. Patients who achieved remission cytological (defined as <5% blasts in the bone marrow aspirate) received consolidation therapy with DEC 20 mg/m2 x 5 days until progression and the remaining patients received a re-induction before start consolidation therapy.
Results
36.4% were de novo AML 63.6% were secondary AML (2 myelofibrosis, 4 MDS and CMML 1). All patients were male with a median age of 82 years old (range 69-86) and 36.4% patients had cytogenetic abnormalities in diagnosis according to European Leukemia Net (ELN): 6 patients were favorable risk, intermediate risk 1 and 3 high-risk. 54.5% patients had> 30% blasts and 45.4% received treatment previously. 91% of patients had some comorbidities. A median of 6 cycles (range 1-10) were administered in total 57 cycles of decitabine. All patients had adverse effects during treatment, the most frequent febrile neutropenia (63%) and there was an early death (<8 weeks) associated with liver failure in a patient previously diagnosed. According to ELN, with induction in 10 days, we had a global response rate of 72.7% (2 CR with cytogenetic remission; 2 CR, 4 CR with incomplete hematologic recovery, 1 PR and 3 patients with refractory disease. Secondary AML, transfusion dependence and number of blasts> 30% at diagnosis, had no effect on treatment response induction. In our study 6 patients died because disease progression infection. Median follow-up of 340 days (range 148- 1506 days) with OS of 63% in 1-year and 45.5% during the follow up with a DFS of 45.5%.
Summary
In our experience, decitabine in 10-day regimen in elderly patients is safe and very effective, even in poor prognosis patients.
Keyword(s): AML, Decitabine, Elderly
Session topic: Publication Only