APPLICABILITY OF THE PATIENT'S 'FITNESS' CRITERIA IN ELDERLY AML IN CLINICAL PRACTICE
(Abstract release date: 05/19/16)
EHA Library. Virijevic M. 06/09/16; 134556; PB1656
Dr. Marijana Virijevic
Contributions
Contributions
Abstract
Abstract: PB1656
Type: Publication Only
Background
The prognosis for acute myeloid leukemia (AML) patients older than 65 years of age is poor. Besides age, comorbidities, a proper assessment of patient’s fitness represents a important step in the therapeutic decision-making process in elderly AML patients. Recent study proposed a set of objective criteria to define pts fit or unfit to conventional intensive chemotherapy (i-CT), non-intensive chemotherapy (ni-CT) or best supportive care (BSC)(Ferrara et al, Leukemia, 2013).
Aims
The aim of this study was to investigate: a) applicability of 'fitness' criteria ; b) the concordance between “fitness” categorization of pts and the type of treatment they actually received; c) the outcome of pts according to “fitness”, to the prognostic stratification of European Leukemianet (ELN) and to the treatment received.
Methods
This single-center study involved 201 adult patients with nonpromyelocytic de novo AML aged ≥ 65 years (median age 70 years, range 65-83 years) diagnosed between January 2009 and December 2015. Pts were categorized according to “fitness” criteria, retrospectively: as fit to i-CT (FIT), unfit to i-CT (UNFIT), or unfit even to ni-CT (FRAIL). According to ELN recommendation, pts were at low-risk (6 pts: 3.2%), intermediate-I (91 pts: 48.4%), intermediate-II (39 pts: 20.7%), or high risk (52 pts: 27.7%). The patients were treated with i-CT 89 (44.5%), 66 pts (33%) ni-CT, such as low-dose cytarabine and 45 pts (22.5%) BSC, including cytoreductive therapies (hydroxyurea) and/or transfusion.
Results
Among 201 pts, 98 (49%) were FIT, 79 (39.5%) were UNFIT, and 23 (11.5%) were FRAIL. Their median age was 67, 73 and 72 years. Median overall survival (OS) of FIT, UNFIT and FRAIL pts was 4, 3 and 1 months, (FIT vs others: p<0.0001, UNFIT vs FRAIL: p=0.012). Overall concordance between “fitness criteria” and the treatment actually received by pts were 77% in FIT, 84% in UNFIT and 96% in FRAIL pts. Median OS of pts receiving i-CT, ni-CT or BSC was 6, 3 and 3 months in FIT (p=0.001); 2,3,4 months in UNFIT (p<0.047). Median OS in FRAIL pts receiving ni-CT or BSC was 1 vs 2 months, (p<0.107). CR rate was 50% in LR, 40% in Int-I, 25.6% in Int-II, 25.5% in HR, (p=0.039). OS rate was 5 in LR/Int-I vs 3 months in Int-II/HR pts (p<0.0001). Comprising ELN prognostic stratification with fitness, the use of i-CT obtained a significantly better median OS of 12 months in FIT pts at ELN LR/Int-I compared to 4 months in pts at Int-II/HR (p= 0,008).
Conclusion
This study has shown that a fitness was significantly related to patient's outcome. Applying the fitness criteria could be useful in clinical practice for therapeutic decision-making in elderly AML patients.
Session topic: E-poster
Keyword(s): Acute myeloid leukemia, Elderly, Therapy
Type: Publication Only
Background
The prognosis for acute myeloid leukemia (AML) patients older than 65 years of age is poor. Besides age, comorbidities, a proper assessment of patient’s fitness represents a important step in the therapeutic decision-making process in elderly AML patients. Recent study proposed a set of objective criteria to define pts fit or unfit to conventional intensive chemotherapy (i-CT), non-intensive chemotherapy (ni-CT) or best supportive care (BSC)(Ferrara et al, Leukemia, 2013).
Aims
The aim of this study was to investigate: a) applicability of 'fitness' criteria ; b) the concordance between “fitness” categorization of pts and the type of treatment they actually received; c) the outcome of pts according to “fitness”, to the prognostic stratification of European Leukemianet (ELN) and to the treatment received.
Methods
This single-center study involved 201 adult patients with nonpromyelocytic de novo AML aged ≥ 65 years (median age 70 years, range 65-83 years) diagnosed between January 2009 and December 2015. Pts were categorized according to “fitness” criteria, retrospectively: as fit to i-CT (FIT), unfit to i-CT (UNFIT), or unfit even to ni-CT (FRAIL). According to ELN recommendation, pts were at low-risk (6 pts: 3.2%), intermediate-I (91 pts: 48.4%), intermediate-II (39 pts: 20.7%), or high risk (52 pts: 27.7%). The patients were treated with i-CT 89 (44.5%), 66 pts (33%) ni-CT, such as low-dose cytarabine and 45 pts (22.5%) BSC, including cytoreductive therapies (hydroxyurea) and/or transfusion.
Results
Among 201 pts, 98 (49%) were FIT, 79 (39.5%) were UNFIT, and 23 (11.5%) were FRAIL. Their median age was 67, 73 and 72 years. Median overall survival (OS) of FIT, UNFIT and FRAIL pts was 4, 3 and 1 months, (FIT vs others: p<0.0001, UNFIT vs FRAIL: p=0.012). Overall concordance between “fitness criteria” and the treatment actually received by pts were 77% in FIT, 84% in UNFIT and 96% in FRAIL pts. Median OS of pts receiving i-CT, ni-CT or BSC was 6, 3 and 3 months in FIT (p=0.001); 2,3,4 months in UNFIT (p<0.047). Median OS in FRAIL pts receiving ni-CT or BSC was 1 vs 2 months, (p<0.107). CR rate was 50% in LR, 40% in Int-I, 25.6% in Int-II, 25.5% in HR, (p=0.039). OS rate was 5 in LR/Int-I vs 3 months in Int-II/HR pts (p<0.0001). Comprising ELN prognostic stratification with fitness, the use of i-CT obtained a significantly better median OS of 12 months in FIT pts at ELN LR/Int-I compared to 4 months in pts at Int-II/HR (p= 0,008).
Conclusion
This study has shown that a fitness was significantly related to patient's outcome. Applying the fitness criteria could be useful in clinical practice for therapeutic decision-making in elderly AML patients.
Session topic: E-poster
Keyword(s): Acute myeloid leukemia, Elderly, Therapy
Abstract: PB1656
Type: Publication Only
Background
The prognosis for acute myeloid leukemia (AML) patients older than 65 years of age is poor. Besides age, comorbidities, a proper assessment of patient’s fitness represents a important step in the therapeutic decision-making process in elderly AML patients. Recent study proposed a set of objective criteria to define pts fit or unfit to conventional intensive chemotherapy (i-CT), non-intensive chemotherapy (ni-CT) or best supportive care (BSC)(Ferrara et al, Leukemia, 2013).
Aims
The aim of this study was to investigate: a) applicability of 'fitness' criteria ; b) the concordance between “fitness” categorization of pts and the type of treatment they actually received; c) the outcome of pts according to “fitness”, to the prognostic stratification of European Leukemianet (ELN) and to the treatment received.
Methods
This single-center study involved 201 adult patients with nonpromyelocytic de novo AML aged ≥ 65 years (median age 70 years, range 65-83 years) diagnosed between January 2009 and December 2015. Pts were categorized according to “fitness” criteria, retrospectively: as fit to i-CT (FIT), unfit to i-CT (UNFIT), or unfit even to ni-CT (FRAIL). According to ELN recommendation, pts were at low-risk (6 pts: 3.2%), intermediate-I (91 pts: 48.4%), intermediate-II (39 pts: 20.7%), or high risk (52 pts: 27.7%). The patients were treated with i-CT 89 (44.5%), 66 pts (33%) ni-CT, such as low-dose cytarabine and 45 pts (22.5%) BSC, including cytoreductive therapies (hydroxyurea) and/or transfusion.
Results
Among 201 pts, 98 (49%) were FIT, 79 (39.5%) were UNFIT, and 23 (11.5%) were FRAIL. Their median age was 67, 73 and 72 years. Median overall survival (OS) of FIT, UNFIT and FRAIL pts was 4, 3 and 1 months, (FIT vs others: p<0.0001, UNFIT vs FRAIL: p=0.012). Overall concordance between “fitness criteria” and the treatment actually received by pts were 77% in FIT, 84% in UNFIT and 96% in FRAIL pts. Median OS of pts receiving i-CT, ni-CT or BSC was 6, 3 and 3 months in FIT (p=0.001); 2,3,4 months in UNFIT (p<0.047). Median OS in FRAIL pts receiving ni-CT or BSC was 1 vs 2 months, (p<0.107). CR rate was 50% in LR, 40% in Int-I, 25.6% in Int-II, 25.5% in HR, (p=0.039). OS rate was 5 in LR/Int-I vs 3 months in Int-II/HR pts (p<0.0001). Comprising ELN prognostic stratification with fitness, the use of i-CT obtained a significantly better median OS of 12 months in FIT pts at ELN LR/Int-I compared to 4 months in pts at Int-II/HR (p= 0,008).
Conclusion
This study has shown that a fitness was significantly related to patient's outcome. Applying the fitness criteria could be useful in clinical practice for therapeutic decision-making in elderly AML patients.
Session topic: E-poster
Keyword(s): Acute myeloid leukemia, Elderly, Therapy
Type: Publication Only
Background
The prognosis for acute myeloid leukemia (AML) patients older than 65 years of age is poor. Besides age, comorbidities, a proper assessment of patient’s fitness represents a important step in the therapeutic decision-making process in elderly AML patients. Recent study proposed a set of objective criteria to define pts fit or unfit to conventional intensive chemotherapy (i-CT), non-intensive chemotherapy (ni-CT) or best supportive care (BSC)(Ferrara et al, Leukemia, 2013).
Aims
The aim of this study was to investigate: a) applicability of 'fitness' criteria ; b) the concordance between “fitness” categorization of pts and the type of treatment they actually received; c) the outcome of pts according to “fitness”, to the prognostic stratification of European Leukemianet (ELN) and to the treatment received.
Methods
This single-center study involved 201 adult patients with nonpromyelocytic de novo AML aged ≥ 65 years (median age 70 years, range 65-83 years) diagnosed between January 2009 and December 2015. Pts were categorized according to “fitness” criteria, retrospectively: as fit to i-CT (FIT), unfit to i-CT (UNFIT), or unfit even to ni-CT (FRAIL). According to ELN recommendation, pts were at low-risk (6 pts: 3.2%), intermediate-I (91 pts: 48.4%), intermediate-II (39 pts: 20.7%), or high risk (52 pts: 27.7%). The patients were treated with i-CT 89 (44.5%), 66 pts (33%) ni-CT, such as low-dose cytarabine and 45 pts (22.5%) BSC, including cytoreductive therapies (hydroxyurea) and/or transfusion.
Results
Among 201 pts, 98 (49%) were FIT, 79 (39.5%) were UNFIT, and 23 (11.5%) were FRAIL. Their median age was 67, 73 and 72 years. Median overall survival (OS) of FIT, UNFIT and FRAIL pts was 4, 3 and 1 months, (FIT vs others: p<0.0001, UNFIT vs FRAIL: p=0.012). Overall concordance between “fitness criteria” and the treatment actually received by pts were 77% in FIT, 84% in UNFIT and 96% in FRAIL pts. Median OS of pts receiving i-CT, ni-CT or BSC was 6, 3 and 3 months in FIT (p=0.001); 2,3,4 months in UNFIT (p<0.047). Median OS in FRAIL pts receiving ni-CT or BSC was 1 vs 2 months, (p<0.107). CR rate was 50% in LR, 40% in Int-I, 25.6% in Int-II, 25.5% in HR, (p=0.039). OS rate was 5 in LR/Int-I vs 3 months in Int-II/HR pts (p<0.0001). Comprising ELN prognostic stratification with fitness, the use of i-CT obtained a significantly better median OS of 12 months in FIT pts at ELN LR/Int-I compared to 4 months in pts at Int-II/HR (p= 0,008).
Conclusion
This study has shown that a fitness was significantly related to patient's outcome. Applying the fitness criteria could be useful in clinical practice for therapeutic decision-making in elderly AML patients.
Session topic: E-poster
Keyword(s): Acute myeloid leukemia, Elderly, Therapy
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