Azacitidine in the treatment of older patients affected by acute myeloid leukemia: A report by the Rete Ematologica Pugliese (REP). Issue 11 (November 2015)

• Record Type: Journal Article
• Authors: Delia, Mario; Carluccio, Paola; Buquicchio, Caterina; Vergine, Carolina; Greco, Giuseppina; Amurri, Barbara; Melpignano, Angela; Melillo, Lorella; Cascavilla, Nicola; Guarini, Attilio; Capalbo, Silvana; Tarantini, Giuseppe; Mazza, Patrizio; Pavone, Vincenzo; Di Renzo, Nicola; Specchia, Giorgina
• Is Part Of: Leukemia research. Volume 39:Issue 11(2015:Nov.)
• Page Start: 1166
• Page End: 1171
• Publication Date: 2015-11
• Subjects: AML -- Older unfit patients -- Treatment; Leukemia -- Periodicals; Leukemia -- Periodicals; Leucémie -- Périodiques; Leukemia; Periodicals; Electronic journals; Electronic journals; 616.9941905
• DOI: 10.1016/j.leukres.2015.08.005
• Languages: English
• ISSNs: 0145-2126

Abstract

Highlights: The azacitidine treatment could be prolonged even in case of primary failure. Unfit AML patients could benefit by treatment regardless of bone marrow blast count. ECOG PS ≥ 2 and cytogenetics impact on response rate. ECOG PS ≥ 2 seems to be correlated with overall survival. 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.