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Annals of Hematology (Browse Results)

Induction chemotherapy versus palliative treatment for acute myeloid leukemia in a consecutive cohort of elderly patients
Thu, 17 May 2012 15:06:38 -0000
Abstract  A retrospective survey of 210 consecutive patients aged ≥65 years (median age 69 years, range 65–88 years) with acute myeloid leukemia (AML) diagnosed at a single center over a 6-year period (January 2001 to December 2006) is presented. De novo AML was diagnosed in 179 (85.2 %) patients and 31 (14.7 %) patients had a secondary AML. Twenty-three patients had M0 (11 %), 36 M1 (17.15 %), 57 M2 (27.1 %), eight M3 (3.8 %), 45 M4 (21.4 %), 31 M5 (14.8 %), one M6 (0.5 %), one M7 (0.5 %), and eight patients had unclassified myeloid leukemia (3.8 %) according to French-American-British (FAB) Study Group Classification. Eight patients with M3 (acute promyelocytic leukemia) were excluded from the study. Cytogenetic analysis was performed in 172/202 (85 %) patients. The normal karyotype was found in 81/172 (47 %), high risk aberrations in 32/172 (18.6 %), and favorable karyotype in 13/172 (7.5 %) patients. Supportive and palliative therapies were applied in 115 (56.9 %) patients, a no induction chemotherapy (NIC) group, and 87 (43.1 %) patients received induction chemotherapy (IC group). Complete remission (CR) was achieved in 45/87 (51.7 %) in the IC group and in 5/115 (4.3 %) in the NIC group of patients. After a median follow up of 4 years, 194 (96 %) patients died. The variables significantly associated with a longer overall survival (OS) by univariate analysis were an age of <75 years, a better ECOG performance status (PS) (p = 0.000, CI 95.0 %, 1.358–2.049), a serum LDH activity <600 U/l (p = 0.000, CI 95.0 %, 1.465–2.946), lower white blood cell (WBC) count at diagnosis (p = 0.011, CI 95.0 %, 1.102–2.100), lower comorbidity HCT-CI index (p = 0.000, CI 95 % 2.209–3.458), absence of splenomegaly (p = 0.015, CI 95.0 %, 1.082–2.102) and hepatomegaly (p = 0.008, CI 95.0 %, 1.125–2.171), and no preceding nonhematological malignancy. Multivariate analysis showed that significant factors affecting OS in the IC group were achievement of CR (p = 0.000), the ECOG PS (p = 0.045) and the ECOG PS (p = 0.000), and HCT-CI (p = 0.000) in the NIC group of elderly patients. The present study suggests that a subgroup of elderly patients with both ECOG PS and HCT-CI ≤ 2 at presentation may be eligible for intensive induction chemotherapy. Content Type Journal ArticleCategory Original ArticlePages 1-8DOI 10.1007/s00277-012-1478-2Authors Milica Colovic, Medical Faculty, University of Belgrade, Dr. Subotića 8, 11000 Belgrade, SerbiaNatasa Colovic, Medical Faculty, University of Belgrade, Dr. Subotića 8, 11000 Belgrade, SerbiaMilica Radojkovic, Medical Faculty, University of Belgrade, Dr. Subotića 8, 11000 Belgrade, SerbiaDejana Stanisavljevic, Medical Faculty, University of Belgrade, Dr. Subotića 8, 11000 Belgrade, SerbiaNada Kraguljac, Clinic of Hematology, Clinical Center of Serbia, Dr. Koste Todorovića 2, 11000 Belgrade, SerbiaGradimir Jankovic, Medical Faculty, University of Belgrade, Dr. Subotića 8, 11000 Belgrade, SerbiaDragica Tomin, Medical Faculty, University of Belgrade, Dr. Subotića 8, 11000 Belgrade, SerbiaNada Suvajdzic, Medical Faculty, University of Belgrade, Dr. Subotića 8, 11000 Belgrade, SerbiaAna Vidovic, Medical Faculty, University of Belgrade, Dr. Subotića 8, 11000 Belgrade, SerbiaHenry Dushan Atkinson, North Middlesex University Hospital, Sterling Way, London, N18 1QX UK Journal Annals of HematologyOnline ISSN 1432-0584Print ISSN 0939-5555

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