Acute myeloid leukemia with translocation (8;21) or inversion (16) in elderly patients treated with conventional chemotherapy: a collaborative study of the French CBF-AML intergroup.
OBJECTIVE
Acute myeloid leukemia (AML) with translocation (t) (8;21) or inversion (inv) (16) is associated with a favorable prognosis when treated with intensive chemotherapy. In elderly patients, these AML types are rare, and intensive treatments are much less tolerated. We conducted a retrospective study to evaluate the characteristics and outcome of AML with t(8;21) or inv(16) in the elderly.


METHODS
Patients with t(8;21) or inv(16) AML who were age 60 years or older and who received at least one course of induction chemotherapy were included. Postremission therapy consisted of low-dose maintenance chemotherapy (n = 72) or intensive consolidation (n = 56).


RESULTS
A total of 147 patients were analyzed. The median age was 67 years. Sixty patients had t(8;21), and 87 patients had inv(16). A total of 129 patients achieved complete response (CR) after one or two induction courses (ie, 88% CR rate), and 15 patients (10%) died early (ie, during the 8 weeks after induction). During a median follow-up of 48 months, the 5-year probabilities of overall survival (OS) and leukemia-free survival (LFS) were 31% and 27%, respectively. Multivariate analysis showed a negative impact of high WBC, impaired performance status, and deletion (9q) on OS and LFS. Administration of intensive consolidation was associated with better LFS only in patients with t(8;21). In addition, the need for critical care during induction independently predicted lower LFS.


CONCLUSIONS
Because of a high CR rate, induction chemotherapy should be considered systematically for elderly patients who have AML with t(8;21) or inv(16). The high risk of relapse suggests that alternative strategies of postremission therapy are warranted.
Prébet
Thomas
T
Institut Paoli-Calmettes, 13009 Marseille, France.
Boissel
Nicolas
N
Reutenauer
Sarah
S
Thomas
Xavier
X
Delaunay
Jacques
J
Cahn
Jean-Yves
JY
Pigneux
Arnaud
A
Quesnel
Bruno
B
Witz
Francis
F
Thépot
Sylvain
S
Ugo
Valérie
V
Terre
Christine
C
Recher
Christian
C
Tavernier
Emmanuelle
E
Hunault
Mathilde
M
Esterni
Benjamin
B
Castaigne
Sylvie
S
Guilhot
François
F
Dombret
Hervé
H
Vey
Norbert
N
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D007446:Chromosome Inversion; D002885:Chromosomes, Human, Pair 16 / Q000235:genetics*; D002891:Chromosomes, Human, Pair 21 / Q000235:genetics*; D002898:Chromosomes, Human, Pair 8 / Q000235:genetics*; D050660:Core Binding Factors / Q000235:genetics; D005260:Female; D006801:Humans; D007951:Leukemia, Myeloid / Q000188:drug therapy* / Q000235:genetics / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D014178:Translocation, Genetic; D016896:Treatment Outcome
D050660:Core Binding Factors