Abstract
Background: The use of azatidine (AZT) is the agent of choice for first line treatment of elderly (age >74 years) patients (pts) with high risk MDS or AML (2015 National Comprehensive Cancer Network Guidelines). The Hematology consultant is frequently involved in the care of very elderly (age >79 years) individuals. Our aim is to report our experience with 3 patient aged 80 or above that received treatment with AZT.
Methods: Retrospective review
Results: We reviewed the medical records of patients treated for high risk MDS or AML at our institution between July 2009 and March 2012. A total of 3 pts aged 80 or above were identified. All three pts were males, and all received AZT 100 mg/m2/day x 7 days subcutaneously in every cycle of 28 days. Patient 1 (aged 81) had 12 % of blasts in the bone marrow (BM), was diagnosed with Refractory Anemia with Excess Blasts-2 (RAEB-2) applying the 2008 World Health Organization Classification (WHO) of MDS. Patient 2 (aged 90) had AML with multilineage dysplasia and 38% blasts in BM. Patient 3 (aged 80) had AML with multilineage dysplasia and 30% blasts in BM. Pts characteristics and results are summarized in Table 1.
Conclusions: In pts diagnosed with high risk MDS or AML, advanced chronological age (> 79 years) alone should not preclude the use of effective and well tolerated therapy. Identification of pts in this geriatric subgroup who may benefit from AZT merits additional research.
| . | Diagnosis . | Age(years) . | Baseline laboratory Peripheral blood . | %Blast in Bone Marrow . | Number of AZT cycles received . | Response . | Survival(months) . |
|---|---|---|---|---|---|---|---|
| Patient 1 | RAEB-2 | 81 | Hb 14 g/dl Platelets 56x10e9/L Leucocytes 1.90x10e9/L (Neutrophils 0.81x10e9/L) | 12 | 11 | CR* in BM after 6 cycles | 17 |
| Patient 2 | AML | 90 | Hb 8.06 g/dl Platelets 20x10e9/L Leucocytes 1.30x10e9/L(Neutrophils 0.64x10e9/L) | 38 | 15 | CR in BM after 7 cycles | 22 |
| Patient 3 | AML | 80 | Hb 7.50 g/dl Platelets 30x10e9/L Leucocytes 6.00x10e9/L(Neutrophils 1.44x10e9/L) | 30 | 19 | CR in BM after 6 cycles | 23 |
| . | Diagnosis . | Age(years) . | Baseline laboratory Peripheral blood . | %Blast in Bone Marrow . | Number of AZT cycles received . | Response . | Survival(months) . |
|---|---|---|---|---|---|---|---|
| Patient 1 | RAEB-2 | 81 | Hb 14 g/dl Platelets 56x10e9/L Leucocytes 1.90x10e9/L (Neutrophils 0.81x10e9/L) | 12 | 11 | CR* in BM after 6 cycles | 17 |
| Patient 2 | AML | 90 | Hb 8.06 g/dl Platelets 20x10e9/L Leucocytes 1.30x10e9/L(Neutrophils 0.64x10e9/L) | 38 | 15 | CR in BM after 7 cycles | 22 |
| Patient 3 | AML | 80 | Hb 7.50 g/dl Platelets 30x10e9/L Leucocytes 6.00x10e9/L(Neutrophils 1.44x10e9/L) | 30 | 19 | CR in BM after 6 cycles | 23 |
*CR: complete remission (<5% blast in aspirate with spicules)
No relevant conflicts of interest to declare.
Author notes
Asterisk with author names denotes non-ASH members.
