title: Induction chemotherapy versus palliative treatment for acute myeloid leukemia in a consecutive cohort of elderly patients.
abstract: A retrospective survey of 210 consecutive patients aged ≥ 65 years (median age 69 years, range 65-88 years) with acute myeloid leukemia (AML) diagnosed at a single center over a 6-year period (January 2001 to December 2006) is presented. De novo AML was diagnosed in 179 (85.2 %) patients and 31 (14.7 %) patients had a secondary AML. Twenty-three patients had M0 (11 %), 36 M1 (17.15 %), 57 M2 (27.1 %), eight M3 (3.8 %), 45 M4 (21.4 %), 31 M5 (14.8 %), one M6 (0.5 %), one M7 (0.5 %), and eight patients had unclassified myeloid leukemia (3.8 %) according to French-American-British (FAB) Study Group Classification. Eight patients with M3 (acute promyelocytic leukemia) were excluded from the study. Cytogenetic analysis was performed in 172/202 (85 %) patients. The normal karyotype was found in 81/172 (47 %), high risk aberrations in 32/172 (18.6 %), and favorable karyotype in 13/172 (7.5 %) patients. Supportive and palliative therapies were applied in 115 (56.9 %) patients, a no induction chemotherapy (NIC) group, and 87 (43.1 %) patients received induction chemotherapy (IC group). Complete remission (CR) was achieved in 45/87 (51.7 %) in the IC group and in 5/115 (4.3 %) in the NIC group of patients. After a median follow up of 4 years, 194 (96 %) patients died. The variables significantly associated with a longer overall survival (OS) by univariate analysis were an age of <75 years, a better ECOG performance status (PS) (p = 0.000, CI 95.0 %, 1.358-2.049), a serum LDH activity <600 U/l (p = 0.000, CI 95.0 %, 1.465-2.946), lower white blood cell (WBC) count at diagnosis (p = 0.011, CI 95.0 %, 1.102-2.100), lower comorbidity HCT-CI index (p = 0.000, CI 95 % 2.209-3.458), absence of splenomegaly (p = 0.015, CI 95.0 %, 1.082-2.102) and hepatomegaly (p = 0.008, CI 95.0 %, 1.125-2.171), and no preceding nonhematological malignancy. Multivariate analysis showed that significant factors affecting OS in the IC group were achievement of CR (p = 0.000), the ECOG PS (p = 0.045) and the ECOG PS (p = 0.000), and HCT-CI (p = 0.000) in the NIC group of elderly patients. The present study suggests that a subgroup of elderly patients with both ECOG PS and HCT-CI ≤ 2 at presentation may be eligible for intensive induction chemotherapy.
authors.affiliation: Medical Faculty, University of Belgrade, Dr. Subotića 8, 11000, Belgrade, Serbia. marcolov@sbb.rs
authors.forename: Milica
authors.initials: M
authors.lastname: Colovic
authors.forename: Natasa
authors.initials: N
authors.lastname: Colovic
authors.forename: Milica
authors.initials: M
authors.lastname: Radojkovic
authors.forename: Dejana
authors.initials: D
authors.lastname: Stanisavljevic
authors.forename: Nada
authors.initials: N
authors.lastname: Kraguljac
authors.forename: Gradimir
authors.initials: G
authors.lastname: Jankovic
authors.forename: Dragica
authors.initials: D
authors.lastname: Tomin
authors.forename: Nada
authors.initials: N
authors.lastname: Suvajdzic
authors.forename: Ana
authors.initials: A
authors.lastname: Vidovic
authors.forename: Henry Dushan
authors.initials: HD
authors.lastname: Atkinson
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use; D016913:Blood Component Transfusion; D002869:Chromosome Aberrations; D015331:Cohort Studies; D015897:Comorbidity; D003561:Cytarabine / Q000008:administration & dosage; D003630:Daunorubicin / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006918:Hydroxyurea / Q000627:therapeutic use; D016130:Immunophenotyping; D053208:Kaplan-Meier Estimate; D007621:Karyotyping; D007951:Leukemia, Myeloid / Q000097:blood / Q000188:drug therapy* / Q000235:genetics / Q000401:mortality / Q000473:pathology; D008297:Male; D010166:Palliative Care; D012074:Remission Induction; D012189:Retrospective Studies; D055771:Serbia / Q000453:epidemiology; D016896:Treatment Outcome
chemical_list: D003561:Cytarabine; D005047:Etoposide; D006918:Hydroxyurea; D003630:Daunorubicin