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Haematologica. 2020 Jan 31;105(2):398-406. doi: 10.3324/haematol.2018.208637. Print 2020.

Comparisons of commonly used front-line regimens on survival outcomes in patients aged 70 years and older with acute myeloid leukemia.

Author information

1
H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL chetasi.talati@gmail.com.
2
Maur y Regional Cancer Center, Columbia, TN.
3
Senior Adult Oncology Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL.
4
Department of Oncology Sciences, University of South Florida, Tampa, FL.
5
H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL.
6
Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, FL.
7
Malignant Hematology Department, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.

Abstract

In older patients with acute myeloid leukemia, the more frequent presence of biologically inherent therapy-resistant disease and increased comorbidities translate to poor overall survival and therapeutic challenges. Optimal front-line therapies for older patients with acute myeloid leukemia remain controversial. We retrospectively evaluated survival outcomes in 980 elderly (≥70 years) acute myeloid leukemia patients from a single institution between 1995 and 2016. Four treatment categories were compared: high-intensity (daunorubicin/cytarabine or equivalent), hypomethylating agent, low-intensity (low-dose cytarabine or similar without hypomethylating agents), and supportive care therapy (including hydroxyurea). At a median follow up of 20.5 months, the median overall survival for the entire cohort was 7.1 months. Multivariate analysis identified secondary acute myeloid leukemia, poor-risk cytogenetics, performance status, front-line therapy, age, white blood cell count, platelet count, and hemoglobin level at diagnosis as having an impact on survival. High-intensity therapy was used in 360 patients (36.7%), hypomethylating agent in 255 (26.0%), low-intensity therapy in 91 (9.3%), and supportive care in 274 (28.0%). Pairwise comparisons between hypomethylating agent therapy and the three other treatment groups demonstrated statistically significant superior median overall survival with hypomethylating agent [14.4 months) vs high-intensity therapy 10.8 months, hazard ratio 1.35, 95% confidence interval (CI): 1.10-1.65; P =0.004], low-intensity therapy (5.9 months, hazard ratio 2.01, 95%CI: 1.53-2.62; P<0.0001), and supportive care (2.1 months, hazard ratio 2.94, 95%CI: 2.39-3.61; P<0.0001). Our results indicate a significant survival benefit with hypomethylating agents compared to high-intensity, low-intensity, or supportive care. Additionally, high-intensity chemotherapy resulted in superior overall outcomes compared to low-intensity therapy and supportive care. Results from this study highlight the need for novel therapeutic approaches besides utilization of intensive chemotherapy in this specific aged population.

PMID:
31073071
DOI:
10.3324/haematol.2018.208637
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