The aims of this study were comparison of overall survival (OS) and complete remission rate (CR) in whole group of acute myeloid leukemia (AML) >60 patients, and in younger older (61 – 70) AML patients in dependency of qualification to risk group according to PALG stratification and a schedule of treatment.

Patients with AML >60 after diagnosis were qualified into the risk groups according to PALG stratification for AML >60. The patients from group 1 patients were receiving intensive induction chemotherapy DAC (daunorubicin, cytarabine, cladribine) or DA (daunorubicin, cytarabine), those from group 2 were receiving cytarabine+thioguanine induction chemotherapy, and those from group 3 chemotherapy with low doses of cytarabine. Patients from first group, who reached CR after induction were receiving consolidation with mitoxantrone + standard dose of cytarabine, and next they were qualified to HSCT or maintenance phase. Patients from group 2 and 3 independently of results of induction were receiving successive cycles of chemotherapy like in first course every 4 weeks to 2 years with very intensive supportive care.

One hundred sixteen patients with untreated AML treated In period 02.2009-12.2012, age 73 (61-89), men 50% were included to this study. Thirty three patients were qualified to group 1, 50 to second and 33 to third. After preliminary analysis, because of similar early and late outcomes of the therapy in group 2 and 3, those groups of patients were joint for next analysis.

Disclosures:

No relevant conflicts of interest to declare.

In comparison of therapy outcomes in group 1 and in group 2+3 of patients with AML >60 significantly higher CR rate in group 1 vs. 2+3 48% vs. 2% (p<0,001) was confirmed but OS was not better after 2 years 10% vs. 8% (p=NS). 
 
The same results were stated In subgroup of age 61-70 of AML patients despite of significantly higher CR in group 1 vs. group 2/3 46% vs. 7% (p=0,01) we did not obtain a benefit in OS after 2 years 9% vs. 25% (p=NS) respectively. 
 
In conclusion we must underline, that in elderly AML patients proper qualification to favorable risk group and as a consequence more intensive induction chemotherapy is a main predictor of better CR rate, but overall survival do not depend on the intensity of the induction therapy. 
 
In comparison of therapy outcomes in group 1 and in group 2+3 of patients with AML >60 significantly higher CR rate in group 1 vs. 2+3 48% vs. 2% (p<0,001) was confirmed but OS was not better after 2 years 10% vs. 8% (p=NS). 
 
The same results were stated In subgroup of age 61-70 of AML patients despite of significantly higher CR in group 1 vs. group 2/3 46% vs. 7% (p=0,01) we did not obtain a benefit in OS after 2 years 9% vs. 25% (p=NS) respectively. 
 
In conclusion we must underline, that in elderly AML patients proper qualification to favorable risk group and as a consequence more intensive induction chemotherapy is a main predictor of better CR rate, but overall survival do not depend on the intensity of the induction therapy. 
 
View Large
Topics:
chemotherapy, neoadjuvant, leukemia, myelocytic, acute, older adult, cytarabine, chemotherapy regimen, daunorubicin, cladribine, complete remission, hematopoietic stem cell transplantation, mitoxantrone

Author notes

*

Asterisk with author names denotes non-ASH members.

© 2013 by The American Society of Hematology
2013
Sign in via your Institution