title: Outcome of older patients with acute myeloid leukemia in first relapse.
abstract: To provide data for future drug evaluation, we analyzed the outcome of 393 patients aged 50 years or older (median, 64 years) with AML in first relapse after treatment in recent ALFA trials. Salvage options were retrospectively classified as follows: best supportive care (BSC), low-dose cytarabine (LDAC), gemtuzumab ozogamicin (GO), intensive chemotherapy (ICT), or ICT combined with GO. Second complete remission (CR2) rate was 31% and median post-relapse survival was 6.8 months (0, 17, 42.5, 53, and 80% and 3.2, 5.6, 8.9, 9, and 19.8 months in BSC, LDAC, GO, ICT, and ICT + GO subsets, respectively). Age, performance status, WBC, CR1 duration, and favorable AML karyotype, but not other cytogenetic or molecular features, influenced post-relapse outcome. Multivariate adjustment and propensity score matching showed that intensive salvage (ICT/ICT+GO/GO versus LDAC/BSC) was associated with longer post-relapse survival, at least in patients with CR1 duration ≥12 months (P = 0.001 and 0.0005, respectively). Of interest, GO appeared to be as effective as standard ICT, and ICT + GO combination more effective than standard ICT. In conclusion, older patients with CR1 duration ≥12 months appeared to benefit from intensive salvage and results observed with GO-containing salvage suggest that GO combination studies should be actively pursued in this setting.
authors.affiliation: Hematology Department, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP), University Paris 7, 1 avenue Claude Vellefaux, Paris, France.
authors.forename: Clémentine
authors.initials: C
authors.lastname: Sarkozy
authors.forename: Claude
authors.initials: C
authors.lastname: Gardin
authors.forename: Nathalie
authors.initials: N
authors.lastname: Gachard
authors.forename: Fathia
authors.initials: F
authors.lastname: Merabet
authors.forename: Pascal
authors.initials: P
authors.lastname: Turlure
authors.forename: Jean-Valère
authors.initials: JV
authors.lastname: Malfuson
authors.forename: Cécile
authors.initials: C
authors.lastname: Pautas
authors.forename: Jean-Baptiste
authors.initials: JB
authors.lastname: Micol
authors.forename: Xavier
authors.initials: X
authors.lastname: Thomas
authors.forename: Bruno
authors.initials: B
authors.lastname: Quesnel
authors.forename: Karine
authors.initials: K
authors.lastname: Celli-Lebras
authors.forename: Claude
authors.initials: C
authors.lastname: Preudhomme
authors.forename: Christine
authors.initials: C
authors.lastname: Terré
authors.forename: Pierre
authors.initials: P
authors.lastname: Fenaux
authors.forename: Sylvie
authors.initials: S
authors.lastname: Chevret
authors.forename: Sylvie
authors.initials: S
authors.lastname: Castaigne
authors.forename: Hervé
authors.initials: H
authors.lastname: Dombret
mesh_terms: D000367:Age Factors; D000368:Aged; D000617:Aminoglycosides / Q000008:administration & dosage; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D003561:Cytarabine / Q000008:administration & dosage; D005260:Female; D000079982:Gemtuzumab; D006801:Humans; D007621:Karyotyping; D015470:Leukemia, Myeloid, Acute / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012074:Remission Induction / Q000379:methods*; D016879:Salvage Therapy / Q000379:methods*; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D000617:Aminoglycosides; D061067:Antibodies, Monoclonal, Humanized; D003561:Cytarabine; D000079982:Gemtuzumab