ELDERLY PATIENTS WITH ACUTE MYELOID LEUKEMIA AND NORMAL KARYOTYPE HAVE A FAVOURABLE OUTCOME AFTER INTENSIVE THERAPEUTIC PROGRAMS
(Abstract release date: 05/19/16)
EHA Library. bernardi m. 06/09/16; 132482; E933
Dr. massimo bernardi
Contributions
Contributions
Abstract
Abstract: E933
Type: Eposter Presentation
Background
outcome of AML patients (pts) older than 60 years is poor because of unfavourable disease characteristics; comorbidities frequently tailor under-powered treatment. When standard induction is given to elderly pts the complete remission (CR) rate is around 55%, median overall survival (OS) after intensive post-remission treatments, such as high dose cytarabine (HDAC) or haematopoietic stem cells transplantation, autologous (AUTO) or allogeneic (ALLO), is about 6 months. Cytogenetic is the principal prognostic factor influencing CR and survival
Aims
retrospective evaluation of data from AML pts ≥ 60 yrs of age who received an intensive treatment program at our Institute
Methods
period 2/2001 to 11/2015, 111 pts. Criteria for pts selection: PS (ECOG) ≤ 2, renal and hepatic parameters within normal ranges or < 2 times normal values, no active infections and cardiac ejection fraction > 50%
Results
median pts age was 68 (60-80). Diagnosis: secondary AML or AML with multilineage dysplasia in 64 cases (6 therapy-related), de novo AML in 47 cases. Cytogenetics: favourable (FAV) 4 cases, adverse (ADV) 15 (complex 11), intermediate (INT) 81, 57 of them were normal karytotype (NK), not evaluable (NE) 11 cases. Molecular analysis (56 pts): 10 NPM1 mut, 9 CEBPA mut, 7 FLT3ITD, 1 FLT3TKD, 1 RUNX1-RUNX1T1, 1 JAK2 mut, 27 negative. Overall, 79 pts (71%) obtained the CR after standard induction chemotherapy (CHT), cumulative incidence (CI) of post-induction treatment related mortality (TRM) was 7.5±4%, median OS was 386 days (12-4725), and 3y OS from diagnosis 29.6±9%, median DFS was 297 days (12-3704), and 3y DFS from diagnosis 20.2±8%. We compared the outcomes of 57 NK pts with 50 INT, UNFAV and NE pts analysed together (noNK). CR rate after induction: 84% (48 pts) and 54% (27 pts) for NK and noNK pts, respectively, p=0.0008. Post-remission treatments (74 pts): 47 NK pts received HDAC in 16 cases, AUTO in 16, ALLO in 9 and CHT in 6, 27 noNK pts received HDAC in 14 cases, AUTO in 4, ALLO in 8 and CHT in 1. CI of post-remission treatment TRM was 13±7% (10 pts, 6 NK and 4 noNK), mostly after ALLO (6 pts). 3y relapse incidence: 55.8±15% for NK, 68.7±15% for noNK, p=0.282. Survival probability of NK pts was significatively higher than no-NK pts: 3y OS from diagnosis was 36.6±12% for NK (median 614 days), 19.4±10% for noNK (median 284 days), p=0.0006, 3y DFS from diagnosis was 27.5±11% for NK (median 453 days), 10.9±7% for noNK (median 219 days), p=0.002. Notably, age did not influence the outcomes: in particular, 3y OS from diagnosis was 46.5±15% if age<70 (median 795 days), and 22.3±13% if age ≥ 70 (median 467 days), p=0.246. Survival of NK pts remained significatively better than no-NK excluding from the analysis cases with FAV and ADV molecular abnormalities (p=0.0037 for OS, p=0.0013 for DFS)
Conclusion
intensive approaches proved feasible in our pts and prolonged survival was observed for several of them. In particular, NK pts showed a survival advantage due to better CR rate after induction and a longer survival free from events, suggesting a higher chemosensitivity of leukemic blasts in absence of cytogenetic abnormalities. Molecular abnormalities and age did not significatively influence the outcome of NK pts. We conclude that absence of cytogenetic abnormalities per se probably defines in the elderly a AML subtype with favourable prognosis. Anyway, strategies to prevent disease relapse also in these pts should be explored
Session topic: E-poster
Keyword(s): Acute myeloid leukemia, Cytogenetics, Elderly, Treatment
Type: Eposter Presentation
Background
outcome of AML patients (pts) older than 60 years is poor because of unfavourable disease characteristics; comorbidities frequently tailor under-powered treatment. When standard induction is given to elderly pts the complete remission (CR) rate is around 55%, median overall survival (OS) after intensive post-remission treatments, such as high dose cytarabine (HDAC) or haematopoietic stem cells transplantation, autologous (AUTO) or allogeneic (ALLO), is about 6 months. Cytogenetic is the principal prognostic factor influencing CR and survival
Aims
retrospective evaluation of data from AML pts ≥ 60 yrs of age who received an intensive treatment program at our Institute
Methods
period 2/2001 to 11/2015, 111 pts. Criteria for pts selection: PS (ECOG) ≤ 2, renal and hepatic parameters within normal ranges or < 2 times normal values, no active infections and cardiac ejection fraction > 50%
Results
median pts age was 68 (60-80). Diagnosis: secondary AML or AML with multilineage dysplasia in 64 cases (6 therapy-related), de novo AML in 47 cases. Cytogenetics: favourable (FAV) 4 cases, adverse (ADV) 15 (complex 11), intermediate (INT) 81, 57 of them were normal karytotype (NK), not evaluable (NE) 11 cases. Molecular analysis (56 pts): 10 NPM1 mut, 9 CEBPA mut, 7 FLT3ITD, 1 FLT3TKD, 1 RUNX1-RUNX1T1, 1 JAK2 mut, 27 negative. Overall, 79 pts (71%) obtained the CR after standard induction chemotherapy (CHT), cumulative incidence (CI) of post-induction treatment related mortality (TRM) was 7.5±4%, median OS was 386 days (12-4725), and 3y OS from diagnosis 29.6±9%, median DFS was 297 days (12-3704), and 3y DFS from diagnosis 20.2±8%. We compared the outcomes of 57 NK pts with 50 INT, UNFAV and NE pts analysed together (noNK). CR rate after induction: 84% (48 pts) and 54% (27 pts) for NK and noNK pts, respectively, p=0.0008. Post-remission treatments (74 pts): 47 NK pts received HDAC in 16 cases, AUTO in 16, ALLO in 9 and CHT in 6, 27 noNK pts received HDAC in 14 cases, AUTO in 4, ALLO in 8 and CHT in 1. CI of post-remission treatment TRM was 13±7% (10 pts, 6 NK and 4 noNK), mostly after ALLO (6 pts). 3y relapse incidence: 55.8±15% for NK, 68.7±15% for noNK, p=0.282. Survival probability of NK pts was significatively higher than no-NK pts: 3y OS from diagnosis was 36.6±12% for NK (median 614 days), 19.4±10% for noNK (median 284 days), p=0.0006, 3y DFS from diagnosis was 27.5±11% for NK (median 453 days), 10.9±7% for noNK (median 219 days), p=0.002. Notably, age did not influence the outcomes: in particular, 3y OS from diagnosis was 46.5±15% if age<70 (median 795 days), and 22.3±13% if age ≥ 70 (median 467 days), p=0.246. Survival of NK pts remained significatively better than no-NK excluding from the analysis cases with FAV and ADV molecular abnormalities (p=0.0037 for OS, p=0.0013 for DFS)
Conclusion
intensive approaches proved feasible in our pts and prolonged survival was observed for several of them. In particular, NK pts showed a survival advantage due to better CR rate after induction and a longer survival free from events, suggesting a higher chemosensitivity of leukemic blasts in absence of cytogenetic abnormalities. Molecular abnormalities and age did not significatively influence the outcome of NK pts. We conclude that absence of cytogenetic abnormalities per se probably defines in the elderly a AML subtype with favourable prognosis. Anyway, strategies to prevent disease relapse also in these pts should be explored
Session topic: E-poster
Keyword(s): Acute myeloid leukemia, Cytogenetics, Elderly, Treatment
Abstract: E933
Type: Eposter Presentation
Background
outcome of AML patients (pts) older than 60 years is poor because of unfavourable disease characteristics; comorbidities frequently tailor under-powered treatment. When standard induction is given to elderly pts the complete remission (CR) rate is around 55%, median overall survival (OS) after intensive post-remission treatments, such as high dose cytarabine (HDAC) or haematopoietic stem cells transplantation, autologous (AUTO) or allogeneic (ALLO), is about 6 months. Cytogenetic is the principal prognostic factor influencing CR and survival
Aims
retrospective evaluation of data from AML pts ≥ 60 yrs of age who received an intensive treatment program at our Institute
Methods
period 2/2001 to 11/2015, 111 pts. Criteria for pts selection: PS (ECOG) ≤ 2, renal and hepatic parameters within normal ranges or < 2 times normal values, no active infections and cardiac ejection fraction > 50%
Results
median pts age was 68 (60-80). Diagnosis: secondary AML or AML with multilineage dysplasia in 64 cases (6 therapy-related), de novo AML in 47 cases. Cytogenetics: favourable (FAV) 4 cases, adverse (ADV) 15 (complex 11), intermediate (INT) 81, 57 of them were normal karytotype (NK), not evaluable (NE) 11 cases. Molecular analysis (56 pts): 10 NPM1 mut, 9 CEBPA mut, 7 FLT3ITD, 1 FLT3TKD, 1 RUNX1-RUNX1T1, 1 JAK2 mut, 27 negative. Overall, 79 pts (71%) obtained the CR after standard induction chemotherapy (CHT), cumulative incidence (CI) of post-induction treatment related mortality (TRM) was 7.5±4%, median OS was 386 days (12-4725), and 3y OS from diagnosis 29.6±9%, median DFS was 297 days (12-3704), and 3y DFS from diagnosis 20.2±8%. We compared the outcomes of 57 NK pts with 50 INT, UNFAV and NE pts analysed together (noNK). CR rate after induction: 84% (48 pts) and 54% (27 pts) for NK and noNK pts, respectively, p=0.0008. Post-remission treatments (74 pts): 47 NK pts received HDAC in 16 cases, AUTO in 16, ALLO in 9 and CHT in 6, 27 noNK pts received HDAC in 14 cases, AUTO in 4, ALLO in 8 and CHT in 1. CI of post-remission treatment TRM was 13±7% (10 pts, 6 NK and 4 noNK), mostly after ALLO (6 pts). 3y relapse incidence: 55.8±15% for NK, 68.7±15% for noNK, p=0.282. Survival probability of NK pts was significatively higher than no-NK pts: 3y OS from diagnosis was 36.6±12% for NK (median 614 days), 19.4±10% for noNK (median 284 days), p=0.0006, 3y DFS from diagnosis was 27.5±11% for NK (median 453 days), 10.9±7% for noNK (median 219 days), p=0.002. Notably, age did not influence the outcomes: in particular, 3y OS from diagnosis was 46.5±15% if age<70 (median 795 days), and 22.3±13% if age ≥ 70 (median 467 days), p=0.246. Survival of NK pts remained significatively better than no-NK excluding from the analysis cases with FAV and ADV molecular abnormalities (p=0.0037 for OS, p=0.0013 for DFS)
Conclusion
intensive approaches proved feasible in our pts and prolonged survival was observed for several of them. In particular, NK pts showed a survival advantage due to better CR rate after induction and a longer survival free from events, suggesting a higher chemosensitivity of leukemic blasts in absence of cytogenetic abnormalities. Molecular abnormalities and age did not significatively influence the outcome of NK pts. We conclude that absence of cytogenetic abnormalities per se probably defines in the elderly a AML subtype with favourable prognosis. Anyway, strategies to prevent disease relapse also in these pts should be explored
Session topic: E-poster
Keyword(s): Acute myeloid leukemia, Cytogenetics, Elderly, Treatment
Type: Eposter Presentation
Background
outcome of AML patients (pts) older than 60 years is poor because of unfavourable disease characteristics; comorbidities frequently tailor under-powered treatment. When standard induction is given to elderly pts the complete remission (CR) rate is around 55%, median overall survival (OS) after intensive post-remission treatments, such as high dose cytarabine (HDAC) or haematopoietic stem cells transplantation, autologous (AUTO) or allogeneic (ALLO), is about 6 months. Cytogenetic is the principal prognostic factor influencing CR and survival
Aims
retrospective evaluation of data from AML pts ≥ 60 yrs of age who received an intensive treatment program at our Institute
Methods
period 2/2001 to 11/2015, 111 pts. Criteria for pts selection: PS (ECOG) ≤ 2, renal and hepatic parameters within normal ranges or < 2 times normal values, no active infections and cardiac ejection fraction > 50%
Results
median pts age was 68 (60-80). Diagnosis: secondary AML or AML with multilineage dysplasia in 64 cases (6 therapy-related), de novo AML in 47 cases. Cytogenetics: favourable (FAV) 4 cases, adverse (ADV) 15 (complex 11), intermediate (INT) 81, 57 of them were normal karytotype (NK), not evaluable (NE) 11 cases. Molecular analysis (56 pts): 10 NPM1 mut, 9 CEBPA mut, 7 FLT3ITD, 1 FLT3TKD, 1 RUNX1-RUNX1T1, 1 JAK2 mut, 27 negative. Overall, 79 pts (71%) obtained the CR after standard induction chemotherapy (CHT), cumulative incidence (CI) of post-induction treatment related mortality (TRM) was 7.5±4%, median OS was 386 days (12-4725), and 3y OS from diagnosis 29.6±9%, median DFS was 297 days (12-3704), and 3y DFS from diagnosis 20.2±8%. We compared the outcomes of 57 NK pts with 50 INT, UNFAV and NE pts analysed together (noNK). CR rate after induction: 84% (48 pts) and 54% (27 pts) for NK and noNK pts, respectively, p=0.0008. Post-remission treatments (74 pts): 47 NK pts received HDAC in 16 cases, AUTO in 16, ALLO in 9 and CHT in 6, 27 noNK pts received HDAC in 14 cases, AUTO in 4, ALLO in 8 and CHT in 1. CI of post-remission treatment TRM was 13±7% (10 pts, 6 NK and 4 noNK), mostly after ALLO (6 pts). 3y relapse incidence: 55.8±15% for NK, 68.7±15% for noNK, p=0.282. Survival probability of NK pts was significatively higher than no-NK pts: 3y OS from diagnosis was 36.6±12% for NK (median 614 days), 19.4±10% for noNK (median 284 days), p=0.0006, 3y DFS from diagnosis was 27.5±11% for NK (median 453 days), 10.9±7% for noNK (median 219 days), p=0.002. Notably, age did not influence the outcomes: in particular, 3y OS from diagnosis was 46.5±15% if age<70 (median 795 days), and 22.3±13% if age ≥ 70 (median 467 days), p=0.246. Survival of NK pts remained significatively better than no-NK excluding from the analysis cases with FAV and ADV molecular abnormalities (p=0.0037 for OS, p=0.0013 for DFS)
Conclusion
intensive approaches proved feasible in our pts and prolonged survival was observed for several of them. In particular, NK pts showed a survival advantage due to better CR rate after induction and a longer survival free from events, suggesting a higher chemosensitivity of leukemic blasts in absence of cytogenetic abnormalities. Molecular abnormalities and age did not significatively influence the outcome of NK pts. We conclude that absence of cytogenetic abnormalities per se probably defines in the elderly a AML subtype with favourable prognosis. Anyway, strategies to prevent disease relapse also in these pts should be explored
Session topic: E-poster
Keyword(s): Acute myeloid leukemia, Cytogenetics, Elderly, Treatment
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