Blood Journal
Leading the way in experimental and clinical research in hematology

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

  1. Hagop Kantarjian*,
  2. Farhad Ravandi,
  3. Susan O'Brien,
  4. Jorge Cortes,
  5. Stefan Faderl,
  6. Guillermo Garcia-Manero,
  7. Elias Jabbour,
  8. William Wierda,
  9. Tapan Kadia,
  10. Sherry Pierce,
  11. Jianqin Shan,
  12. Michael Keating, and
  13. Emil J. Freireich
  1. 1 Department of Leukemia, The University of Texas M. D. Anderson Cancer Center, Houston, TX, United States
  1. * Corresponding author; email: hkantarj{at}mdanderson.org

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.