Efficacy and safety of decitabine in treatment of elderly patients with acute myeloid leukemia: A systematic review and meta-analysis

Abstract

Elderly patients with acute myeloid leukemia (AML) have limited treatment options concerned about their overall fitness and potential treatment related mortality. Although a number of clinical trials demonstrated benefits of decitabine treatment in elderly AML patients, the results remains controversial. A meta-analysis was performed to evaluate efficacy and safety of decitabine in treatment of elderly AML patients. Eligible studies were identified from PubMed, Web of Science, Embase and Cochrane Library. Nine published studies were included in the meta-analysis, enrolling 718 elderly AML patients. The efficacy outcomes were complete remission (CR), overall response rate (ORR) and overall survival (OS). Safety was evaluated based on treatment related grades 3–4 adverse events (AEs) and early death (ED) rate. Pooled estimates with 95% confidence interval (CI) for CR, ORR and OS were 27% (95% CI 19%–36%), 37% (95% CI 28%–47%) and 8.09 months (95% CI 5.77–10.41), respectively. The estimated treatment related early death (ED) incidences were within 30-days 7% (95% CI 2%–11%) and 60-days 17% (95% CI 11%–22%), respectively. Thrombocytopenia was the most common grades 3–4 AEs. Subgroup analyses of age, cytogenetics risk, AML type and bone marrow blast percentage showed no significant differences of treatment response to decitabine. In conclusion, decitabine is an effective and well-tolerated therapeutic alternative with acceptable side effects in elderly AML patients.

Use of decitabine for patients with refractory or relapsed acute myeloid leukemia: a systematic review and meta-analysis

“…A recent meta-analysis has reported the CR rate of 27% (95% CI: 19-36), RR 37% (95% CI: 28-47) and median survival of 8.09 months (95% CI: 5.77-10.41) with decitabine monotherapy to previously untreated elderly (over 60 years of age) AML patients [44]. In Figure 3.…”

Development and in vitro evaluations of new decitabine nanocarriers for the treatment of acute myeloid leukemia

“…35,36 Encapsulation of a drug in carriers (microparticles or nanoparticles) is a strategy largely used to control drug release and decrease side effects. A release study using a Float-a-Lyzer ® device, in PBS pH 7.4, in sink conditions, was performed to study the release kinetics of decitabine from LNCs.…”

Safety and efficacy of talacotuzumab plus decitabine or decitabine alone in patients with acute myeloid leukemia not eligible for chemotherapy: results from a multicenter, randomized, phase 2/3 study

“…The incidence of AML increases progressively with age; advanced age, comorbidities, compromised organ functions contribute to poor prognosis in older patients with AML [16]. Intensive and aggressive chemotherapy may improve the efficacy outcomes in these patients, but toxicity and adverse events limit their use in elderly patients unfit for intensive therapy [17]. Until recently, the recommended standard of care for these patients is low-intensity therapies such as decitabine, azacitidine, and low-dose cytarabine, but the prognosis is suboptimal [12,15,18].…”