title: Prognostic features for response and survival in elderly patients with de novo acute myeloid leukemia treated with mitoxantrone and intermediate dose cytarabine.
abstract: Forty-three fit elderly patients with de novo acute myeloid leukemia (AML) received chemotherapy with mitoxantrone and intermediate dose cytarabine (MIDAC) in a phase II clinical trial conducted by the Australasian Leukaemia and Lymphoma Group. The main aim of the study was to evaluate the tolerability and efficacy of MIDAC in inducing durable remissions. While the chemotherapy was generally well tolerated, less than half the patients achieved complete remission (CR) after induction and many of those in CR could not receive planned consolidation cycles. The median overall survival for all patients was 6.5 months and the median disease-free survival for those achieving CR was 8.3 months. Only 2 patients survived beyond 4 years. Factors significantly associated with shorter survival were adverse cytogenetics, marrow dysplasia and increasing age. These results suggest that only selected elderly patients with AML are likely to benefit from aggressive chemotherapy and that novel therapies are required to improve the poor prognosis of this group.
authors.affiliation: Department of Haematology, Royal Melbourne Hospital, Parkville, Victoria, Australia. andrew.grigg@mh.org.au
authors.forename: A P
authors.initials: AP
authors.lastname: Grigg
authors.forename: J
authors.initials: J
authors.lastname: Reynolds
authors.forename: A
authors.initials: A
authors.lastname: McQuillan
authors.forename: S K
authors.initials: SK
authors.lastname: Juneja
authors.forename: J
authors.initials: J
authors.lastname: Di Iulio
authors.forename: C
authors.initials: C
authors.lastname: Hui
authors.forename: C
authors.initials: C
authors.lastname: Smith
authors.forename: R
authors.initials: R
authors.lastname: Kimber
authors.forename: K F
authors.initials: KF
authors.lastname: Bradstock
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D003561:Cytarabine / Q000008:administration & dosage* / Q000009:adverse effects; D018572:Disease-Free Survival; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000145:classification / Q000175:diagnosis / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D008942:Mitoxantrone / Q000008:administration & dosage* / Q000009:adverse effects; D018579:Patient Selection; D010865:Pilot Projects; D011379:Prognosis; D012074:Remission Induction; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D003561:Cytarabine; D008942:Mitoxantrone