Intensive chemotherapy does not benefit most older patients (age 70 years or older) with acute myeloid leukemia.
Patients ≥ 70 years of age with acute myeloid leukemia (AML) have a poor prognosis. Recent studies suggested that intensive AML-type therapy is tolerated and may benefit most. We analyzed 446 patients ≥ 70 years of age with AML (≥ 20% blasts) treated with cytarabine-based intensive chemotherapy between 1990 and 2008 to identify risk groups for high induction (8-week) mortality. Excluding patients with favorable karyotypes, the overall complete response rate was 45%, 4-week mortality was 26%, and 8-week mortality was 36%. The median survival was 4.6 months, and the 1-year survival rate was 28%. Survival was similar among patients treated before 2000 and since 2000. A multivariate analysis of prognostic factors for 8-week mortality identified the following to be independently adverse: age ≥ 80 years, complex karyotypes, (≥ 3 abnormalities), poor performance (2-4 Eastern Cooperative Oncology Group), and elevated creatinine > 1.3 mg/dL. Patients with none (28%), 1 (40%), 2 (23%), or ≥ 3 factors (9%) had estimated 8-week mortality rates of 16%, 31%, 55%, and 71% respectively. The 8-week mortality model also predicted for differences in complete response and survival rates. In summary, the prognosis of most patients (72%) ≥ 70 years of age with AML is poor with intensive chemotherapy (8-week mortality ≥ 30%; median survival < 6 months).
Kantarjian
Hagop
H
Department of Leukemia, University of Texas M. D. Anderson Cancer Center, Houston, TX, USA. hkantarj@mdanderson.org
Ravandi
Farhad
F
O'Brien
Susan
S
Cortes
Jorge
J
Faderl
Stefan
S
Garcia-Manero
Guillermo
G
Jabbour
Elias
E
Wierda
William
W
Kadia
Tapan
T
Pierce
Sherry
S
Shan
Jianqin
J
Keating
Michael
M
Freireich
Emil J
EJ
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use*; D003561:Cytarabine / Q000627:therapeutic use*; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000175:diagnosis* / Q000188:drug therapy*; D011379:Prognosis; D012307:Risk Factors; D015996:Survival Rate
D000964:Antimetabolites, Antineoplastic; D003561:Cytarabine