title: Outcomes of elderly de novo acute myeloid leukemia treated by a risk-adapted approach based on age, comorbidity, and performance status.
abstract: Several criteria to define fitness for induction chemotherapy in elderly acute myeloid leukemia (AML) have been proposed; however, no studies have reported outcomes according to the application of a risk-adapted approach. We treated 256 consecutive patients with elderly AML (≥60 years) with a risk-adapted approach based on age, comorbidity score (CS), and performance status (ECOG). Eighty-five low-risk patients (age ≤ 65 years and ECOG 0-1 with CS < 2), 86 intermediate-risk patients (age > 65 years or ECOG = 2 with CS < 2), and 85 high-risk patients (ECOG > 2 or CS ≥ 2) were treated with induction chemotherapies, including standard intensive regimens, abbreviated-scheduled regimens, and modified low-dose cytarabine with oral etoposide (mLDAC), respectively. Overall response rates (ORR; complete response and complete response with incomplete recovery) for these three groups were 71.8%, 60.5%, and 41.2%, respectively, without a significant difference in early death rate (17.6%, 25.6%, 23.5%, P = 0.415). Among three abbreviated-scheduled regimens, a gemtuzumab ozogamicin (GO)-containing regimen (n = 43) showed a similar ORR rate (72.1%) to the intensive regimen. After achieving remission, 142 patients went on postremission treatments, including reduced-intensity allogeneic transplantation (RIC, n = 41), standard consolidation (n = 71), and repeated mLDAC (n = 30) according to donor availability, age, ECOG, and CS. Multivariate analyses revealed that not only RIC, but also repeated mLDAC, resulted in significantly superior survival outcomes to standard consolidation independent of age, ECOG, and CS. Clinical benefits of mLDAC for high-risk patients and abbreviated induction with GO for intermediate-risk patients should be confirmed with further studies. Our results also suggest that RIC should be actively considered in elderly AML as a postremission treatment.
authors: Department of Hematology, Catholic Blood and Marrow Transplantation Center, Seoul St. Mary's hospital, The Catholic University of Korea, Seoul, Korea.
authors: Jae-Ho
authors: JH
authors: Yoon
authors: Byung-Sik
authors: BS
authors: Cho
authors: Hee-Je
authors: HJ
authors: Kim
authors: Jung-Ho
authors: JH
authors: Kim
authors: Seung-Hwan
authors: SH
authors: Shin
authors: Seung-Ah
authors: SA
authors: Yahng
authors: Sung-Eun
authors: SE
authors: Lee
authors: Ki-Seong
authors: KS
authors: Eom
authors: Yoo-Jin
authors: YJ
authors: Kim
authors: Seok
authors: S
authors: Lee
authors: Chang-Ki
authors: CK
authors: Min
authors: Seok-Goo
authors: SG
authors: Cho
authors: Dong-Wook
authors: DW
authors: Kim
authors: Jong-Wook
authors: JW
authors: Lee
authors: Woo-Sung
authors: WS
authors: Min
authors: Chong-Won
authors: CW
authors: Park
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D064591:Allografts; D000617:Aminoglycosides / Q000008:administration & dosage; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D015897:Comorbidity; D060830:Consolidation Chemotherapy; D003561:Cytarabine / Q000008:administration & dosage / Q000031:analogs & derivatives; D003630:Daunorubicin / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D000079982:Gemtuzumab; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D015255:Idarubicin / Q000008:administration & dosage; D053208:Kaplan-Meier Estimate; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D008942:Mitoxantrone / Q000008:administration & dosage; D012074:Remission Induction; D012306:Risk; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D000617:Aminoglycosides; D061067:Antibodies, Monoclonal, Humanized; D003561:Cytarabine; D005047:Etoposide; D000079982:Gemtuzumab; C015019:enocitabine; D008942:Mitoxantrone; D015255:Idarubicin; D003630:Daunorubicin