Conservative treatment for patients over 80 years with acute myelogenous leukemia

Latagliata, Roberto; Carmosino, Ida; Breccia, Massimo; Borza, Paola Anticoli; Bongarzoni, Velia; Copia, Carolina; Spadea, Antonio; Pinazzi, Beatrice; Frattarelli, Natalia; Ferrara, Felicetto; Petti, Maria Concetta; Mandelli, Franco

doi:10.1002/ajh.10235

Cited by 13 publications

(10 citation statements)

References 6 publications

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“…Our study demonstrated that decitabine increases thrombocyte and hemoglobin levels and reduces blast cell levels to some extent in some patients, although none of the patients achieved PR or CR. In particular, the mean survival of the 5 patients was 19.8 months, which is significantly longer than the survival reported for AML patients aged 80 and above (28,29). It is suggested that, although the present decitabine dosage cannot suppress blast cell to normal levels, it may slow down the growth of blast cells.…”

Section: Discussionmentioning

confidence: 56%

Successful treatment with low-dose decitabine in acute myelogenous leukemia in elderly patients over 80 years old: Five case reports

Lin

Zhu

et al. 2013

Oncology Letters

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The incidence of acute myelogenous leukemia (AML) in patients over 80 years old is >20 times greater than that observed in younger patients. Previously, no standard treatment protocol for elderly patients with AML existed, however the development of hypomethylating agents, including decitabine, has brought about promising results in AML. In the present study, we report on the usage of a lower than routine dosage of decitabine in patients over 80 years old with AML. Since January 2010, 5 patients diagnosed with AML over the age of 80 years old received treatment with decitabine in our hospital. Decitabine was administered at a dose of 10–15 mg/m2 and repeated every other day for a total of 5 days. This cycle was repeated for ∼6 weeks. The 5 patients received a total of 19 cycles of treatment with decitabine. No patient achieved complete or partial remission. An antileukemic effect was observed in 25% of courses (3/12). An increase in platelet count of >20×109/l was observed in 26.3% (5/19) of cycles compared with previous treatment. An increase in hemoglobin concentration of >20 g/l was observed in 36.8% (7/19) of cycles in comparison to previous treatment, four of which achieved normal hemoglobin levels. One patient became red blood cell transfusion-independent. The median survival time was 19.8±4.8 months. Survival time from decitabine administration to mortality was 13.2±5.1 months. The main side-effect was bone marrow suppression with grade III–IV thrombocytopenia, grade III–IV leukocytopenia, grade III–IV neutropenia and anemia accounting for 94.7% (18/19), 47.4% (9/19), 89.5% (17/19) and 21.1% (4/19), respectively. Severe infection or bleeding was not observed and no patient stopped treatment due to adverse effects. In conclusion, extremely low-dose decitabine may be used safely in elderly patients and achieved longer survival times than reported previously in AML patients aged 80 and above. It is suggested that complete remission may not be the primary objective, while improvement of quality of life may be a better choice in AML patients over 80 years old. The cases observed in our study were limited, so more cases are required for further study.

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Section: Discussionmentioning

confidence: 56%

Successful treatment with low-dose decitabine in acute myelogenous leukemia in elderly patients over 80 years old: Five case reports

Lin

Zhu

et al. 2013

Oncology Letters

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“…Older age strongly influenced decisions about administering induction chemotherapy [17][18][19][20][21][22][23][24]. Those receiving induction chemotherapy were younger [median age 59 years (range 18-85)] versus those receiving supportive care [73 years (range 28-90), P < 0.0001].…”

Section: Demographics Leukemia Phenotype and Therapymentioning

confidence: 99%

Day 14 bone marrow biopsy in predicting complete remission and survival in acute myeloid leukemia

et al. 2008

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We retrospectively analyzed 194 previously untreated acute myeloid leukemia (AML) patients to evaluate the role of Day 14 bone marrow (BM) biopsy in predicting complete remission (CR). Sixty-seven percent received induction therapy. Achieving Day 14 BM 5% blasts was strongly predictive of Day 28 CR with 90% sensitivity and 79% positive predictive value; but weak 43% specificity and 29% negative predictive value. Day 14 BM biopsy is highly sensitive in predicting CR, but did not predict overall survival. Some patients with BM blast >5% at Day 14 may still achieve a Day 28 CR, and not necessarily need reinduction therapy though high risk cytochemical or cytogenetic phenotype predicts a need for retreatment. Am. J. Hematol. 83:446-450, 2008. V

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“…In addition, it should be considered that very elderly patients (i.e. those aged more than 75 years) are poorly compliant to protocols requiring frequent clinical and laboratory controls [28][29][30].…”

Section: Discussionmentioning

confidence: 99%

Heterogeneity in the therapeutic approach to relapsed elderly patients with acute myeloid leukaemia: a survey from the Gruppo Italiano Malattie Ematologiche dell' Adulto (GIMEMA) Acute Leukaemia Working Party

Ferrara

Fazi

Venditti

et al. 2008

Hematological Oncology

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The percentage of long-term survivors in acute myeloid leukaemia (AML) in the elderly does not exceed 10-15% of patients enrolled into clinical trials because of lower complete remission (CR) rates and higher incidence of relapse. However, few data are available as the treatment of elderly patients with relapsed disease is concerned. The aim of this study was of collecting data on criteria adopted for the treatment of these patients. A questionnaire was e-mailed to 32 haematologic institutions involved in the Gruppo Italiano per le Malattie Ematologiche dell'Adulto (GIMEMA) group. Questions to be addressed regarded: (1) per cent of relapsed elderly patients treated with aggressive salvage chemotherapy; (2) the selection criteria adopted for inclusion into intensive reinduction; (3) the specific treatment adopted; (4) the treatment given to patients not eligible for intensive salvage. Per cent of patients enrolled into aggressive salvage regimens varied from 10 to 80% (median 50%). The most frequent factor influencing the therapeutic choice was performance status (97%). Additional factors were age >70 years (44%) and duration of first CR (53%). Fludarabine including regimens were most frequently used as aggressive salvage therapy (59%), while gemtuzumab ozogamicin was adopted in various combinations at 11 out of 32 institutions (34%). For patients not eligible to aggressive therapy, the most frequent approach included hydroxyurea (59%). Low dose ARA-C (LDARA-C) was adopted at five centres: as single agent (n = 1), with 6-thioguanine (n = 1), with vitamin D3 and all-trans retinoic acid (ATRA) (n = 2), or with ATRA alone (n = 1). The FLT3 inhibitor CEP-701 was used at one centre. We conclude that the treatment of AML in elderly relapsed patients is extremely heterogeneous. A marked selection is operated as to inclusion into aggressive salvage regimens and only a small minority of patients are offered experimental approaches.

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Conservative treatment for patients over 80 years with acute myelogenous leukemia

Cited by 13 publications

References 6 publications

Successful treatment with low-dose decitabine in acute myelogenous leukemia in elderly patients over 80 years old: Five case reports

Successful treatment with low-dose decitabine in acute myelogenous leukemia in elderly patients over 80 years old: Five case reports

Day 14 bone marrow biopsy in predicting complete remission and survival in acute myeloid leukemia

Heterogeneity in the therapeutic approach to relapsed elderly patients with acute myeloid leukaemia: a survey from the Gruppo Italiano Malattie Ematologiche dell' Adulto (GIMEMA) Acute Leukaemia Working Party

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