Feasibility and results of autologous stem cell transplantation in de novo acute myeloid leukemia in patients over 60 years old. Results of the CETLAM AML-99 protocol.
OBJECTIVE
The benefits of high-dose cytarabine, anthracyclines and hematopoietic stem cell transplantation in the treatment of acute myeloid leukemia (AML) are greater in younger rather than in older patients. We assessed the proportion of patients over 60 years with de novo AML who qualified for intensive therapy and determined the feasibility and results of autologous stem cell transplantation (ASCT) in first complete remission (CR).


METHODS
Induction therapy included idarubicin, cytarabine and etoposide. Patients who achieved CR received one cycle of mitoxantrone and cytarabine and ASCT as consolidation therapies.


RESULTS
Over a 4-year period, 258 patients were registered of whom 135 (52%) were enrolled for intensive treatment. The CR rate was 61%, advanced age (p=0.033) and unfavorable cytogenetics (p=0.015) emerged as independent negative prognostic factors for CR. The 2-year overall survival (OS) was 23 % (CI 14%-30%) and was poorer in patients with unfavorable cytogenetics (p=0.035), age over 70 years (p=0.019) or leukocytosis (p=0.006). Only 27% of the potential candidates underwent ASCT. The probability of 2-year leukemia-free survival after consolidation was 39% (CI 6%-71%) for these patients and 22% (CI 6% - 39%) for candidate patients not undergoing ASCT (p=0.07).


CONCLUSIONS
Over 25% of the patients 60 to 70 years with de novo AML benefit from standard intensive treatment. In these patients, ASCT has a tolerable toxicity and may have a positive impact on leukemia-free survival.
Oriol
Albert
A
CETLAM Group, Catalonia, Spain. aoriol@ns.hugtip.scs.es
Ribera
Josep-Maria
JM
Esteve
Jordi
J
Guàrdia
Ramon
R
Brunet
Salut
S
Bueno
Javier
J
Pedro
Carme
C
Llorente
Andrés
A
Tormo
Mar
M
Besalduch
Joan
J
Sánchez
Josep-Maria
JM
Batlle
Montserrat
M
Vivancos
Pilar
P
Carreras
Enric
E
Vilà
Josep-Maria
JM
Julià
Antoni
A
Sierra
Jordi
J
Montserrat
Emili
E
Feliu
Evarist
E
D000208:Acute Disease; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D003561:Cytarabine / Q000008:administration & dosage; D018572:Disease-Free Survival; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D015255:Idarubicin / Q000008:administration & dosage; D007951:Leukemia, Myeloid / Q000188:drug therapy / Q000628:therapy*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008942:Mitoxantrone / Q000008:administration & dosage; D016016:Proportional Hazards Models; D012074:Remission Induction; D014182:Transplantation, Autologous
D003561:Cytarabine; D005047:Etoposide; D008942:Mitoxantrone; D015255:Idarubicin