title: Outcome of elderly patients with acute promyelocytic leukemia: results of the German Acute Myeloid Leukemia Cooperative Group.
abstract: Despite improvement of prognosis, older age remains a negative prognostic factor in acute promyelocytic leukemia (APL). Reports on disease characteristics and outcome of older patients are conflicting. We therefore analyzed 91 newly diagnosed APL patients aged 60 years or older (30 % of 305 adults with APL) registered by the German AML Cooperative Group (AMLCG) since 1994; 68 patients (75 %) were treated in studies, 23 (25 %) were non-eligible, and 31 % had high-risk APL. Fifty-six patients received induction therapy with all-trans retinoic acid and TAD (6-thioguanine, cytarabine, daunorubicin), and consolidation and maintenance therapy. Treatment intensification with a second induction cycle (high dose cytarabine, mitoxantrone; HAM) was optional (n = 14). Twelve patients were randomized to another therapy not considered in this report. The early death rate was 48 % in non-eligible and 19 % in study patients. With the AMLCG regimen, 7-year overall, event-free and relapse-free survival (RFS) and cumulative incidence of relapse were 45 %, 40 %, 48 %, and 24 %, respectively. In patients treated with TAD-HAM induction, 7-year RFS was superior (83 %; p = 0.006) compared to TAD only, and no relapse was observed. In our registered elderly patients, we see a high rate of non-eligibility for treatment in studies and of high-risk APL. In patients who can undergo a curative approach, intensified chemotherapy is highly effective, but is restricted to a selection of patients. Therefore, new less toxic treatment approaches with broader applicability are needed. Elderly patients might be a particular target group for concepts with arsenic trioxide.
authors.affiliation: Department of Hematology and Oncology, University Hospital Mannheim, Mannheim, Germany. eva.lengfelder@umm.de
authors.forename: Eva
authors.initials: E
authors.lastname: Lengfelder
authors.forename: Benjamin
authors.initials: B
authors.lastname: Hanfstein
authors.forename: Claudia
authors.initials: C
authors.lastname: Haferlach
authors.forename: Jan
authors.initials: J
authors.lastname: Braess
authors.forename: Utz
authors.initials: U
authors.lastname: Krug
authors.forename: Karsten
authors.initials: K
authors.lastname: Spiekermann
authors.forename: Torsten
authors.initials: T
authors.lastname: Haferlach
authors.forename: Karl-Anton
authors.initials: KA
authors.lastname: Kreuzer
authors.forename: Hubert
authors.initials: H
authors.lastname: Serve
authors.forename: Heinz A
authors.initials: HA
authors.lastname: Horst
authors.forename: Susanne
authors.initials: S
authors.lastname: Schnittger
authors.forename: Carlo
authors.initials: C
authors.lastname: Aul
authors.forename: Beate
authors.initials: B
authors.lastname: Schultheis
authors.forename: Philipp
authors.initials: P
authors.lastname: Erben
authors.forename: Stephanie
authors.initials: S
authors.lastname: Schneider
authors.forename: Carsten
authors.initials: C
authors.lastname: Müller-Tidow
authors.forename: Bernhard
authors.initials: B
authors.lastname: Wörmann
authors.forename: Wolfgang E
authors.initials: WE
authors.lastname: Berdel
authors.forename: Cristina
authors.initials: C
authors.lastname: Sauerland
authors.forename: Achim
authors.initials: A
authors.lastname: Heinecke
authors.forename: Rüdiger
authors.initials: R
authors.lastname: Hehlmann
authors.forename: Wolf-Karsten
authors.initials: WK
authors.lastname: Hofmann
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Hiddemann
authors.forename: Thomas
authors.initials: T
authors.lastname: Büchner
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use; D000077237:Arsenic Trioxide; D001152:Arsenicals / Q000008:administration & dosage; D001853:Bone Marrow / Q000473:pathology; D003561:Cytarabine / Q000008:administration & dosage; D003630:Daunorubicin / Q000008:administration & dosage; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D015473:Leukemia, Promyelocytic, Acute / Q000097:blood / Q000188:drug therapy / Q000453:epidemiology* / Q000235:genetics / Q000401:mortality; D007958:Leukocyte Count; D060046:Maintenance Chemotherapy; D008297:Male; D008875:Middle Aged; D008942:Mitoxantrone / Q000008:administration & dosage; D015337:Multicenter Studies as Topic / Q000706:statistics & numerical data; D010087:Oxides / Q000008:administration & dosage; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D012074:Remission Induction; D012306:Risk; D013866:Thioguanine / Q000008:administration & dosage; D016896:Treatment Outcome; D014212:Tretinoin / Q000008:administration & dosage
chemical_list: D001152:Arsenicals; D010087:Oxides; D003561:Cytarabine; D014212:Tretinoin; D008942:Mitoxantrone; D013866:Thioguanine; D000077237:Arsenic Trioxide; D003630:Daunorubicin