title: Aggressive salvage treatment is not appropriate for the majority of elderly patients with acute myeloid leukemia relapsed from first complete remission.
abstract: OBJECTIVE
  The prognosis of acute myeloid leukemia (AML) in the elderly is still poor because of different reasons, including a high incidence of relapse. The aim of this study was to investigate whether aggressive salvage chemotherapy (CHT) results in an actual survival advantage in elderly patients with relapsed AML, as well as to compare hospitalization and load of supportive treatment between patients receiving aggressive management or only palliation.
  
  
  METHODS
  One hundred and fifty consecutive patients with relapsed AML (median age 66 years) were analyzed. At relapse, 99 (66%) were treated with CHT, and 51 had palliative management.
  
  
  RESULTS
  Second complete remission (CR2) was achieved in 36/99 patients (36%) receiving CHT, while no CR was observed in the other group (p<0.001). Induction death rate was 22%, while 41% were resistant to CHT. The median survival from relapse was 4 months for the whole patient population; according to management, it was 5 months and 3 months for CHT and palliation, respectively (p=0.01). As to patients given CHT, a CR1 duration of more than 12 months was the only parameter significantly related to a better clinical outcome (survival from relapse: 8 vs. 4 months, p=0.002; CR2 duration: 11 vs. 5 months, p=0.001, respectively). Finally, patients managed with palliation required less hospitalization and less supportive therapy as compared to the CHT group.
  
  
  CONCLUSIONS
  Aggressive chemotherapy results in an actual survival advantage only for a minority of elderly patients with relapsed AML, i.e. those with CR1 lasting for more than 12 months.
authors.affiliation: Divisione di Ematologia, Ospedale Cardarelli, Napoli, Italy. felicettoferrara@katamail.com
authors.forename: F
authors.initials: F
authors.lastname: Ferrara
authors.forename: F
authors.initials: F
authors.lastname: Morabito
authors.forename: R
authors.initials: R
authors.lastname: Latagliata
authors.forename: B
authors.initials: B
authors.lastname: Martino
authors.forename: M
authors.initials: M
authors.lastname: Annunziata
authors.forename: E
authors.initials: E
authors.lastname: Oliva
authors.forename: E M
authors.initials: EM
authors.lastname: Schiavone
authors.forename: F
authors.initials: F
authors.lastname: Pollio
authors.forename: S
authors.initials: S
authors.lastname: Palmieri
authors.forename: G
authors.initials: G
authors.lastname: Gianfaldoni
authors.forename: F
authors.initials: F
authors.lastname: Leoni
mesh_terms: D000208:Acute Disease; D000367:Age Factors; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007951:Leukemia, Myeloid / Q000188:drug therapy* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012008:Recurrence; D016879:Salvage Therapy / Q000009:adverse effects / Q000592:standards* / Q000706:statistics & numerical data; D016019:Survival Analysis; D016896:Treatment Outcome