ACUTE MYELOID LEUKEMIA IN THE ELDERLY TREATED AGGRESSIVELY IN A NON-TRANSPLANT CENTER: A SINGLE CENTER OF EXPERIENCE
(Abstract release date: 05/19/16)
EHA Library. Mota D. 06/09/16; 134562; PB1662
Dr. Diana Mota
Contributions
Contributions
Abstract
Abstract: PB1662
Type: Publication Only
Background
Most cases of Acute Myeloid Leukemia (AML) occur in older patients in whom, considering biological variation associated with chemoresistance and comordibities, defines a challenging population. While overall survival (OS) in patients with AML decreases with age, most studies performed in elderly patients showed Complete Remission (CR) rates between 50 and 60% if they are treated aggressively.
Aims
This study aims to characterize an elderly population with a diagnosis of AML (considering age subgroups, cytogenetic risk groups, type of intended treatment and use of consolidation) and to analyze the impact of different treatment approaches on complete response (CR) and their overall survival (OS).
Methods
We analysed 157 patients aged over 60 years with the diagnosis of AML (excluding acute promyelocytic leukemia, according the 2008 World Health Organization classification) treated agressively. Retrospective analysis of clinical and laboratory data, between 1st January 2005 and 31st December 2015.
Results
Of all patients, 55% were male. The median age at diagnosis was 67 years and 68% of patients were over 65. In this population 49% (N=77) of AML were secondary to another haematological disorder (40%, N=63), or as consequence of prior chemotherapy for another malignancy (9%, N=14). According to the French-British-American classification, the most frequent subtypes were M4 (23%), followed by the M2 and M1 subtypes (22% each) and M5 (19%). We obtained conventional karyotype cytogenetic results in 64% of our patients, of whom 4% were of low risk, 45% of intermediate risk and 15% of high risk. We choose an aggressive treatment strategy in these 157 patients, pre-selected according to age, performance-status and comorbidities, attaining a CR rate of 52%. The main induction regimens were MIC/MICE (N=113), ICE/3+7 (N=30), ARA-C (N=12). OS was respectively 43%, 49% and 8% at 10 months, with significant difference between MIC/MICE and ICE/3+7 when compared with ARA-C regimen (p<0.05). During hematological recovery, 62% presented febrile neutropenia, 10% presented mucositis (grade ≥3) and 8% presented palmar-plantar rash with cytarabine. The median days to hematological recovery was 28. The use of consolidation therapy after CR in this age group didn’t improve overall survival (62 vs 53% at 12 months, p=N.S.). OS was 15% at 12 months and 10% at 24 months with a statistically significant difference in survival between the 60-65, and over 65 age groups at 12 months (20% vs 12%; p<0.05). Progression of the haematological malignancy was the primary cause of death in 43% of patients and infection in 22%; 6% died from bleeding complications.
Conclusion
Although we concluded that a significant proportion of patients treated aggressively obtain CR, in our series the use of consolidation didn’t improve OS. However aggressive treatment strategies may induce several complications so treatment decisions should be individualized to each patient, according to risk factors, such as age and cytogenetics, performance status and co-morbidities. The recommendation is to whenever possible enroll the patient in a clinical trial.
Session topic: E-poster
Keyword(s): Acute myeloid leukemia, Elderly
Type: Publication Only
Background
Most cases of Acute Myeloid Leukemia (AML) occur in older patients in whom, considering biological variation associated with chemoresistance and comordibities, defines a challenging population. While overall survival (OS) in patients with AML decreases with age, most studies performed in elderly patients showed Complete Remission (CR) rates between 50 and 60% if they are treated aggressively.
Aims
This study aims to characterize an elderly population with a diagnosis of AML (considering age subgroups, cytogenetic risk groups, type of intended treatment and use of consolidation) and to analyze the impact of different treatment approaches on complete response (CR) and their overall survival (OS).
Methods
We analysed 157 patients aged over 60 years with the diagnosis of AML (excluding acute promyelocytic leukemia, according the 2008 World Health Organization classification) treated agressively. Retrospective analysis of clinical and laboratory data, between 1st January 2005 and 31st December 2015.
Results
Of all patients, 55% were male. The median age at diagnosis was 67 years and 68% of patients were over 65. In this population 49% (N=77) of AML were secondary to another haematological disorder (40%, N=63), or as consequence of prior chemotherapy for another malignancy (9%, N=14). According to the French-British-American classification, the most frequent subtypes were M4 (23%), followed by the M2 and M1 subtypes (22% each) and M5 (19%). We obtained conventional karyotype cytogenetic results in 64% of our patients, of whom 4% were of low risk, 45% of intermediate risk and 15% of high risk. We choose an aggressive treatment strategy in these 157 patients, pre-selected according to age, performance-status and comorbidities, attaining a CR rate of 52%. The main induction regimens were MIC/MICE (N=113), ICE/3+7 (N=30), ARA-C (N=12). OS was respectively 43%, 49% and 8% at 10 months, with significant difference between MIC/MICE and ICE/3+7 when compared with ARA-C regimen (p<0.05). During hematological recovery, 62% presented febrile neutropenia, 10% presented mucositis (grade ≥3) and 8% presented palmar-plantar rash with cytarabine. The median days to hematological recovery was 28. The use of consolidation therapy after CR in this age group didn’t improve overall survival (62 vs 53% at 12 months, p=N.S.). OS was 15% at 12 months and 10% at 24 months with a statistically significant difference in survival between the 60-65, and over 65 age groups at 12 months (20% vs 12%; p<0.05). Progression of the haematological malignancy was the primary cause of death in 43% of patients and infection in 22%; 6% died from bleeding complications.
Conclusion
Although we concluded that a significant proportion of patients treated aggressively obtain CR, in our series the use of consolidation didn’t improve OS. However aggressive treatment strategies may induce several complications so treatment decisions should be individualized to each patient, according to risk factors, such as age and cytogenetics, performance status and co-morbidities. The recommendation is to whenever possible enroll the patient in a clinical trial.
Session topic: E-poster
Keyword(s): Acute myeloid leukemia, Elderly
Abstract: PB1662
Type: Publication Only
Background
Most cases of Acute Myeloid Leukemia (AML) occur in older patients in whom, considering biological variation associated with chemoresistance and comordibities, defines a challenging population. While overall survival (OS) in patients with AML decreases with age, most studies performed in elderly patients showed Complete Remission (CR) rates between 50 and 60% if they are treated aggressively.
Aims
This study aims to characterize an elderly population with a diagnosis of AML (considering age subgroups, cytogenetic risk groups, type of intended treatment and use of consolidation) and to analyze the impact of different treatment approaches on complete response (CR) and their overall survival (OS).
Methods
We analysed 157 patients aged over 60 years with the diagnosis of AML (excluding acute promyelocytic leukemia, according the 2008 World Health Organization classification) treated agressively. Retrospective analysis of clinical and laboratory data, between 1st January 2005 and 31st December 2015.
Results
Of all patients, 55% were male. The median age at diagnosis was 67 years and 68% of patients were over 65. In this population 49% (N=77) of AML were secondary to another haematological disorder (40%, N=63), or as consequence of prior chemotherapy for another malignancy (9%, N=14). According to the French-British-American classification, the most frequent subtypes were M4 (23%), followed by the M2 and M1 subtypes (22% each) and M5 (19%). We obtained conventional karyotype cytogenetic results in 64% of our patients, of whom 4% were of low risk, 45% of intermediate risk and 15% of high risk. We choose an aggressive treatment strategy in these 157 patients, pre-selected according to age, performance-status and comorbidities, attaining a CR rate of 52%. The main induction regimens were MIC/MICE (N=113), ICE/3+7 (N=30), ARA-C (N=12). OS was respectively 43%, 49% and 8% at 10 months, with significant difference between MIC/MICE and ICE/3+7 when compared with ARA-C regimen (p<0.05). During hematological recovery, 62% presented febrile neutropenia, 10% presented mucositis (grade ≥3) and 8% presented palmar-plantar rash with cytarabine. The median days to hematological recovery was 28. The use of consolidation therapy after CR in this age group didn’t improve overall survival (62 vs 53% at 12 months, p=N.S.). OS was 15% at 12 months and 10% at 24 months with a statistically significant difference in survival between the 60-65, and over 65 age groups at 12 months (20% vs 12%; p<0.05). Progression of the haematological malignancy was the primary cause of death in 43% of patients and infection in 22%; 6% died from bleeding complications.
Conclusion
Although we concluded that a significant proportion of patients treated aggressively obtain CR, in our series the use of consolidation didn’t improve OS. However aggressive treatment strategies may induce several complications so treatment decisions should be individualized to each patient, according to risk factors, such as age and cytogenetics, performance status and co-morbidities. The recommendation is to whenever possible enroll the patient in a clinical trial.
Session topic: E-poster
Keyword(s): Acute myeloid leukemia, Elderly
Type: Publication Only
Background
Most cases of Acute Myeloid Leukemia (AML) occur in older patients in whom, considering biological variation associated with chemoresistance and comordibities, defines a challenging population. While overall survival (OS) in patients with AML decreases with age, most studies performed in elderly patients showed Complete Remission (CR) rates between 50 and 60% if they are treated aggressively.
Aims
This study aims to characterize an elderly population with a diagnosis of AML (considering age subgroups, cytogenetic risk groups, type of intended treatment and use of consolidation) and to analyze the impact of different treatment approaches on complete response (CR) and their overall survival (OS).
Methods
We analysed 157 patients aged over 60 years with the diagnosis of AML (excluding acute promyelocytic leukemia, according the 2008 World Health Organization classification) treated agressively. Retrospective analysis of clinical and laboratory data, between 1st January 2005 and 31st December 2015.
Results
Of all patients, 55% were male. The median age at diagnosis was 67 years and 68% of patients were over 65. In this population 49% (N=77) of AML were secondary to another haematological disorder (40%, N=63), or as consequence of prior chemotherapy for another malignancy (9%, N=14). According to the French-British-American classification, the most frequent subtypes were M4 (23%), followed by the M2 and M1 subtypes (22% each) and M5 (19%). We obtained conventional karyotype cytogenetic results in 64% of our patients, of whom 4% were of low risk, 45% of intermediate risk and 15% of high risk. We choose an aggressive treatment strategy in these 157 patients, pre-selected according to age, performance-status and comorbidities, attaining a CR rate of 52%. The main induction regimens were MIC/MICE (N=113), ICE/3+7 (N=30), ARA-C (N=12). OS was respectively 43%, 49% and 8% at 10 months, with significant difference between MIC/MICE and ICE/3+7 when compared with ARA-C regimen (p<0.05). During hematological recovery, 62% presented febrile neutropenia, 10% presented mucositis (grade ≥3) and 8% presented palmar-plantar rash with cytarabine. The median days to hematological recovery was 28. The use of consolidation therapy after CR in this age group didn’t improve overall survival (62 vs 53% at 12 months, p=N.S.). OS was 15% at 12 months and 10% at 24 months with a statistically significant difference in survival between the 60-65, and over 65 age groups at 12 months (20% vs 12%; p<0.05). Progression of the haematological malignancy was the primary cause of death in 43% of patients and infection in 22%; 6% died from bleeding complications.
Conclusion
Although we concluded that a significant proportion of patients treated aggressively obtain CR, in our series the use of consolidation didn’t improve OS. However aggressive treatment strategies may induce several complications so treatment decisions should be individualized to each patient, according to risk factors, such as age and cytogenetics, performance status and co-morbidities. The recommendation is to whenever possible enroll the patient in a clinical trial.
Session topic: E-poster
Keyword(s): Acute myeloid leukemia, Elderly
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