Background: The early mortality rates in older patients (generally defined as those > 60 years) following standard therapy for acute myeloid leukemia (AML), has spurred numerous trials of “targeted” treatments, typically limited to this age group. Here we examine whether younger patients with Zubrod performance status (PS) 2 might also be candidates for these therapies.

Patients and Methods: We reviewed the records of 1841 patients 40 years or older with newly diagnosed AML (no acute promyelocytic leukemia) who received cytarabine-containing therapy at M. D. Anderson from 1980 to 2007. We chose patients with the following pretreatment characteristics because they are conventional criteria for entry onto trials of new therapies: PS 0–2, bilirubin < 2 mg/dL, and creatinine < 2 mg/dL. We calculated death rates by age and PS at 28 and 42 days after initiation of induction therapy.

Results: Induction death rates in patients with AML by age and performance status The 28-day death rates in patients age 50–59 years with PS 2 were similar to those in patients ≥ 60 years with PS 0–1, and the 42-day death rates in the patients age 50–59 years with PS 2 were similar to those in patients age 60–79 with PS 0–1.

Conclusion: Because of the high death rates following AML therapy in patients age 50–59 with PS 2, these patients should be eligible for targeted treatments now limited to older patients.

Age, yrsPerformance StatusNo. of PatientsDead by day 28, %Dead by day 42 %
40–49 0–1 288 7 9 
40–49 2 38 5 5 
50–59 0–1 405 4 6 
50–59 2 85 14 15 
60–69 0–1 423 8 11 
60–69 2 111 17 17 
70–79 0–1 301 12 16 
70–79 2 124 23 33 
≥80 0–1 45 13 20 
≥ 80 2 21 38 43 
Age, yrsPerformance StatusNo. of PatientsDead by day 28, %Dead by day 42 %
40–49 0–1 288 7 9 
40–49 2 38 5 5 
50–59 0–1 405 4 6 
50–59 2 85 14 15 
60–69 0–1 423 8 11 
60–69 2 111 17 17 
70–79 0–1 301 12 16 
70–79 2 124 23 33 
≥80 0–1 45 13 20 
≥ 80 2 21 38 43 
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Topics:
karnofsky performance status, leukemia, myelocytic, acute, molecular targeted therapy, older adult, acute promyelocytic leukemia, bilirubin, creatinine, cytarabine, neoadjuvant therapy

Author notes

Disclosure: No relevant conflicts of interest to declare.

2007, The American Society of Hematology
2007
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