title: Intensive chemotherapy, azacitidine, or supportive care in older acute myeloid leukemia patients: an analysis from a regional healthcare network.
abstract: We assessed in a French regional healthcare network the distribution of treatments, prognostic factors, and outcome of 334 newly diagnosed acute myeloid leukemia patients aged 60 years or older over a 4-year period of time (2007-2010). Patients were selected in daily practice for intensive chemotherapy (n = 115), azacitidine (n = 95), or best supportive care (n = 124). In these three groups, median overall survival was 18.9, 11.3, and 1.8 months, respectively. In the azacitidine group, multivariate analysis showed that overall survival was negatively impacted by higher age (P = 0.010 for one unit increase), unfavorable cytogenetics (P = 0.001), lymphocyte count <0.5 G/L (P = 0.015), and higher lactate dehydrogenase level (P = 0.005 for one unit increase). We compared the survival of patients treated by azacitidine versus intensive chemotherapy and best supportive care using time-dependent analysis and propensity score matching. Patients treated by intensive chemotherapy had a better overall survival compared with those treated by azacitidine from 6 months after diagnosis, whereas patients treated by azacitidine had a better overall survival compared with those treated by best supportive care from 1 day after diagnosis. This study of "real life" practice shows that there is a room for low intensive therapies such as azacitidine in selected elderly acute myeloid leukemia patients.
authors.affiliation: Département d'Hématologie-Médecine Interne, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer Toulouse Oncopole, Toulouse, France; Service d'Hématologie, Hôpitaux Universitaires de Strasbourg, F-67098, Strasbourg, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Bories
authors.forename: Sarah
authors.initials: S
authors.lastname: Bertoli
authors.forename: Emilie
authors.initials: E
authors.lastname: Bérard
authors.forename: Julie
authors.initials: J
authors.lastname: Laurent
authors.forename: Eliane
authors.initials: E
authors.lastname: Duchayne
authors.forename: Audrey
authors.initials: A
authors.lastname: Sarry
authors.forename: Eric
authors.initials: E
authors.lastname: Delabesse
authors.forename: Odile
authors.initials: O
authors.lastname: Beyne-Rauzy
authors.forename: Françoise
authors.initials: F
authors.lastname: Huguet
authors.forename: Christian
authors.initials: C
authors.lastname: Récher
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols; D001374:Azacitidine / Q000627:therapeutic use*; D005260:Female; D005602:France; D006801:Humans; D007770:L-Lactate Dehydrogenase; D015470:Leukemia, Myeloid, Acute / Q000175:diagnosis / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010166:Palliative Care; D011379:Prognosis; D011446:Prospective Studies; D012041:Regional Medical Programs; D016019:Survival Analysis
chemical_list: D000964:Antimetabolites, Antineoplastic; D007770:L-Lactate Dehydrogenase; D001374:Azacitidine