The benefit of induction chemotherapy in patients age > or = 75 years.
BACKGROUND
Patients age > or = 75 years with acute myeloid leukemia (AML) generally are offered palliative treatments instead of induction chemotherapy. The authors conducted a retrospective study comparing the outcomes among these elderly patients with the outcomes among younger patients to assess the impact of intensive treatment approaches in this age group.


METHODS
One hundred ten consecutive patients age > or = 75 years with newly diagnosed AML (excluding patients with acute promyelocytic leukemia) were treated in the authors' center over 10 years. Initial treatment was comprised of anthracycline-based induction chemotherapy (i.e., intravenous idarubicin or daunorubicin for 3 days plus cytarabine [ARAC] for 7 days [3 + 7 regimen] or oral idarubicin) for 62 patients (56%), antimetabolite-based chemotherapy (including low-dose ARAC, oral 6-mercaptopurine plus methotrexate, or hydroxyurea) for 40 patients (36%), and supportive care only for 8 patients (7%). Results were compared with the results from 200 patients ages 65-74 years who were treated during the same period.


RESULTS
A complete response (CR) to anthracycline-based induction therapy was achieved by 23 of 62 patients (37%), and the 2-year overall survival rate was 22% (which was not statistically different from the group of patients ages 65-74 years). In a multivariate analysis of the entire study group (310 patients), treatment (anthracycline-based vs. other) and age as continuous variable were found to affect survival significantly. In a Landmark analysis, the achievement of a CR translated into improved survival in patients age > or = 75 years.


CONCLUSIONS
Patients age > or = 75 years should not be excluded systematically from intensive chemotherapy regimens. Decisions should be based on stratification systems that include functional status and comorbidity assessments as well as prognostic factors, such as cytogenetics.
Vey
Norbert
N
Department of Hematology, Institut Paoli-Calmettes, Marseille, France. veyn@marseille.fnclcc.fr
Coso
Diane
D
Bardou
Valerie-Jeanne
VJ
Stoppa
Anne-Marie
AM
Braud
Anne-Chantal
AC
Bouabdallah
Reda
R
Sainty
Daniele
D
Mozziconacci
Marie-Joelle
MJ
Lafage
Marina
M
Damaj
Gandhi
G
Blaise
Didier
D
Gastaut
Jean-Albert
JA
Maraninchi
Dominique
D
D000368:Aged; D018943:Anthracyclines / Q000627:therapeutic use*; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy*; D008297:Male; D012074:Remission Induction; D012189:Retrospective Studies; D016896:Treatment Outcome
D018943:Anthracyclines; D000964:Antimetabolites, Antineoplastic