title: Intensive chemotherapy in patients aged 70 years or older newly diagnosed with acute myeloid leukemia.
abstract: Acute myeloid leukemia (AML) represents a major therapeutic challenge in the elderly. Because of the high treatment-related mortality and poor overall outcomes of remission induction therapy, many older patients are not considered candidates for intensive chemotherapy. The current study evaluated prognostic factors for achievement of complete remission (CR) in newly diagnosed elderly AML patients who were treated with initial intensive chemotherapy. The study included 62 newly diagnosed AML patients ≥ 70 years who were treated with intensive chemotherapy. The overall response rate (CR and CRp) was 56%. Patients with favorable or intermediate cytogenetics (p=0.0036) as well as those with primary AML (p=0.0212) had a higher response rate. The median overall survival for all patients was 6.85 months (95% CI 3.7-13.5 months). The median overall survival for patients achieving remission after intensive induction chemotherapy was significantly higher than those who did not respond to therapy (20.4 months vs. 3.5 months, p<0.001). The all-cause 4-week mortality rate was 11%, and the all-cause 8-week mortality rate was 17.7%. A subgroup of elderly patients may benefit more from initial intensive induction chemotherapy, specifically those patients with performance status able to tolerate induction chemotherapy and favorable cytogenetic status. However, despite high rates of initial CR, relapse rates are still high, suggesting that alternative strategies of postremission therapy are warranted.
authors.affiliation: Division of Hematology and Oncology, University of Pittsburgh Cancer Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors.forename: Kelly
authors.initials: K
authors.lastname: Ross
authors.forename: Amanda L
authors.initials: AL
authors.lastname: Gillespie-Twardy
authors.forename: Mounzer
authors.initials: M
authors.lastname: Agha
authors.forename: Anastasios
authors.initials: A
authors.lastname: Raptis
authors.forename: Jing-Zhou
authors.initials: JZ
authors.lastname: Hou
authors.forename: Rafic
authors.initials: R
authors.lastname: Farah
authors.forename: Robert L
authors.initials: RL
authors.lastname: Redner
authors.forename: Annie
authors.initials: A
authors.lastname: Im
authors.forename: Shrina
authors.initials: S
authors.lastname: Duggal
authors.forename: Fei
authors.initials: F
authors.lastname: Ding
authors.forename: Yan
authors.initials: Y
authors.lastname: Lin
authors.forename: Michael
authors.initials: M
authors.lastname: Boyiadzis
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome