title: Azacitidine in the treatment of older patients affected by acute myeloid leukemia: A report by the Rete Ematologica Pugliese (REP).
abstract: The optimal treatment of older patients (>65 years) with acute myeloid leukemia (AML) remains challenging in daily clinical practice; a choice has to be made between intensive chemotherapy and best supportive care. To guide physicians, several prognostic factors have been identified and risk scores developed. Recently, the DNA methyltransferase inhibitor azacitidine has become available for use in MDS and AML patients with up to 30% bone marrow blasts. However, limited data are available on the outcome of older unfit AML patients, regardless of their bone marrow blast count. We retrospectively analyzed the outcome of 90 newly diagnosed older unfit AML patients in 9 Institutions from the Apulia Region (REP). Responder patients (evaluation performed after 4 cycles of treatment even in cases of primary failure) showed a better overall survival than non responders (23 vs 6 months, p<.001). ECOG PS≥2 seems to be correlated with OS in multivariate analysis, while neither primary treatment failure (documented after 2 cycles) nor bone marrow blast count were correlated with a worse overall survival either at univariate (22 vs 29 months, p=.ns; 16 vs 19 months, p=.ns) or multivariate analysis. Overall, the results of our retrospective analysis seem to confirm the efficacy of AZA treatment for this unfit AML patients setting, in terms of both CR and OS, regardless of the bone marrow blasts count, while primary treatment failure should not lead to a discontinuation of treatment.
authors.affiliation: Hematology and Bone Marrow Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy. Electronic address: mario.delia@tiscali.it.
authors.forename: Mario
authors.initials: M
authors.lastname: Delia
authors.affiliation: Hematology and Bone Marrow Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Carluccio
authors.affiliation: Hematology, Ospedale Di Miccoli, Barletta, Italy.
authors.forename: Caterina
authors.initials: C
authors.lastname: Buquicchio
authors.affiliation: Hematology, Ospedale Vito Fazzi, Lecce, Italy.
authors.forename: Carolina
authors.initials: C
authors.lastname: Vergine
authors.affiliation: Hematology, Ospedale Cardinale Panico, Tricase, LE, Italy.
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Greco
authors.affiliation: Hematology, Ospedale San Giuseppe Moscati, Taranto, Italy.
authors.forename: Barbara
authors.initials: B
authors.lastname: Amurri
authors.affiliation: Hematology, Ospedale Perrino, Brindisi, Italy.
authors.forename: Angela
authors.initials: A
authors.lastname: Melpignano
authors.affiliation: Hematology, Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo, FG, Italy.
authors.forename: Lorella
authors.initials: L
authors.lastname: Melillo
authors.affiliation: Hematology, Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo, FG, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Cascavilla
authors.affiliation: Hematology, Istituto Tumori Giovanni Paolo II, Bari, Italy.
authors.forename: Attilio
authors.initials: A
authors.lastname: Guarini
authors.affiliation: Hematology, Ospedali Riuniti, Foggia, Italy.
authors.forename: Silvana
authors.initials: S
authors.lastname: Capalbo
authors.affiliation: Hematology, Ospedale Di Miccoli, Barletta, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Tarantini
authors.affiliation: Hematology, Ospedale San Giuseppe Moscati, Taranto, Italy.
authors.forename: Patrizio
authors.initials: P
authors.lastname: Mazza
authors.affiliation: Hematology, Ospedale Cardinale Panico, Tricase, LE, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Pavone
authors.affiliation: Hematology, Ospedale Vito Fazzi, Lecce, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Di Renzo
authors.affiliation: Hematology and Bone Marrow Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy.
authors.forename: Giorgina
authors.initials: G
authors.lastname: Specchia
keywords: AML; Older unfit patients; Treatment