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Intensive chemotherapy does not benefit most older patients (age 70 years or older) with acute myeloid leukemia

Hagop Kantarjian, Farhad Ravandi, Susan O'Brien, Jorge Cortes, Stefan Faderl, Guillermo Garcia-Manero, Elias Jabbour, William Wierda, Tapan Kadia, Sherry Pierce, Jianqin Shan, Michael Keating, Emil J. Freireich

Abstract

Patients 70 years or older with acute myeloid leukemia (AML) have a poor prognosis. Recent studies suggested that intensive AML-type therapy is tolerated and may benefit most. We analyzed 446 patients 70 years or older with AML (≥ 20% blasts) treated with cytarabine-based intensive chemotherapy between 1990 and 2008, to identify risk groups for high induction (8-week) mortality. Excluding patients with favorable karyotypes, the overall CR rate was 45%, 4-week mortality 26%, and 8-week mortality 36%. The median survival was 4.6 months, and the one-year survival rate 28%. Survival was similar among patients treated before 2000 and since 2000. A multivariate analysis of prognostic factors for 8-week mortality identified the following to be independently adverse: age > 80 years, complex karyotypes, (≥ 3 abnormalities), poor performance (2-4 ECOG), and elevated creatinine >1.3 mg %. Patients with none, (28%), 1 (40%), 2 (23%), or ≥ 3 factors (9%) had estimated 8-week mortality rates of 16%, 31%, 55% and 71% respectively. The 8-week mortality model also predicted for differences in CR and survival rates. In summary, the prognosis of most patients (72%) aged 70 years or older with AML is poor with intensive chemotherapy (8-week mortality; median survival < 6 months).

  • Submitted March 25, 2010.
  • Accepted June 23, 2010.