Treatment of elderly patients with acute myeloid leukemia with azacitidine results in fewer hospitalization days and infective complications but similar survival compared with intensive chemotherapy

Lao, Zhentang; Yiu, Richard; Wong, Gee Chuan; Ho, A Y L

doi:10.1111/ajco.12331

Cited by 11 publications

(7 citation statements)

References 37 publications

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“…62,64,[85][86][87][88][89][90][91][92][93][94][95][96][97] Eighteen additional studies were reviewed but excluded from the meta-analyses due to lack of data on the outcomes prioritized by the expert panel. [98][99][100][101][102][103][104][105][106][107][108][109][110][111][112][113][114][115][116] Given the challenges in randomizing patients to intensive or less-intensive treatments, most of the included studies were observational. 62,85,86,93,95,96 Two were randomized clinical trials (RCTs).…”

Section: Recommendationmentioning

confidence: 99%

American Society of Hematology 2020 guidelines for treating newly diagnosed acute myeloid leukemia in older adults

et al. 2020

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Background: Older adults with acute myeloid leukemia (AML) represent a vulnerable population in whom disease-based and clinical risk factors, patient goals, prognosis, and practitioner- and patient-perceived treatment risks and benefits influence treatment recommendations. Objective: These evidence-based guidelines of the American Society of Hematology (ASH) are intended to support patients, clinicians, and other health care professionals in their decisions about management of AML in older adults. Methods: ASH formed a multidisciplinary guideline panel that included specialists in myeloid leukemia, geriatric oncology, patient-reported outcomes and decision-making, frailty, epidemiology, and methodology, as well as patients. The McMaster Grading of Recommendations Assessment, Development and Evaluation (GRADE) Centre supported the guideline-development process, including performing systematic evidence reviews (up to 24 May 2019). The panel prioritized clinical questions and outcomes according to their importance to patients, as judged by the panel. The panel used the GRADE approach, including GRADE’s Evidence-to-Decision frameworks, to assess evidence and make recommendations, which were subject to public comment. Results: The panel agreed on 6 critical questions in managing older adults with AML, mirroring real-time practitioner-patient conversations: the decision to pursue antileukemic treatment vs best supportive management, the intensity of therapy, the role and duration of postremission therapy, combination vs monotherapy for induction and beyond, duration of less-intensive therapy, and the role of transfusion support for patients no longer receiving antileukemic therapy. Conclusions: Treatment is recommended over best supportive management. More-intensive therapy is recommended over less-intensive therapy when deemed tolerable. However, these recommendations are guided by the principle that throughout a patient’s disease course, optimal care involves ongoing discussions between clinicians and patients, continuously addressing goals of care and the relative risk-benefit balance of treatment.

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Section: Recommendationmentioning

confidence: 99%

American Society of Hematology 2020 guidelines for treating newly diagnosed acute myeloid leukemia in older adults

et al. 2020

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“…The patients had to be hospitalized during 4.8% and 9.2% of the median overall survival time, which is less than reported elsewhere. 13 Early mortality within the first sixty days was low (7.9%).…”

Section: Survival Risk Factorsmentioning

confidence: 95%

“…Most patients (58%) had poor or very-poor risk AML. Patients received a median of 7 (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13) therapy cycles. The median overall-survival in the newly diagnosed and the previously treated patient groups were 308 (175-580) and 346 (293-628) days, respectively (p=0.94).…”

mentioning

confidence: 99%

Efficacy of Azacitidine in De Novo and Relapsed Acute Myeloid Leukemia: A Retrospective Comparative Study

Gemuenden

Benz

Senn

et al. 2015

Clinical Lymphoma Myeloma and Leukemia

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Introduction: Azacitidine is a therapeutic alternative to low-dose cytarabine in patients with acute myeloid leukemia (AML) who are unfit for intensive chemotherapy. Patients and Methods: We retrospectively analyzed all AML patients treated with azacitidine at the University Hospital Zurich and the Kantonsspital Munsterlingen between January 2005 and December 2011. The primary end point was overall survival (OS). Results: Thirty-eight patients were included in the analysis. Twenty-one (55%) patients had newly diagnosed AML, 14 (37%) had relapsed AML, and 3 (8%) underwent bridging therapy before allogeneic stem-cell transplantation. Age at diagnosis was 72 years in the newly diagnosed cohort and 58 years in the relapsed cohort, 19 (50%) patients were female, 20 (53%) patients were transfusion dependent, and bone marrow blast count was 43% (interquartile range, 26-80). Most patients (58%) had poor or very poor risk AML. Patients received a median (range) of 7 (3-13) therapy cycles. The median (range) OS in the newly diagnosed and previously treated patient groups were 308 (175-580) days and 346 (293-628) days, respectively (P = .94). Median OS in the 3 patients treated before allogeneic stemcell transplantation has not been reached. Sixty-day mortality was 7.9%, with no difference between the 2 groups. Ongoing or increasing transfusion dependency was associated with adverse outcome (hazard ratio, 3.09; 95% confidence interval, 1.29-7.37, P = .011). Conclusion: Treatment with azacitidine led to a median OS of 10 months in both a previously untreated and a previously treated frail AML patient cohort. A positive effect in transfusion dependency was observed in 29% of these patients and was associated with better survival. AbstractIntroduction: Azacitidine is a therapeutic alternative to low-dose cytarabine in patients with

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“…[3][4][5][6] However, the comparative value of regimens of different intensities is uncertain, especially in older and medically infirm patients. [7][8][9][10][11][12] As a reflection of the uncertainty surrounding best practices in this patient population, Clini calTr ials.gov lists 33 ongoing trials using regimens of varying intensities for initial induction therapy in older AML patients. Comparing the outcomes among regimens of different levels of intensity is hampered by the lack of widely accepted definitions of "intensity."…”

Section: Introductionmentioning

confidence: 99%

Regimen‐intensity per count‐recovery and hospitalization index: A new tool to assign regimen intensity for AML

et al. 2020

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Background Low‐intensity regimens have been increasingly used to treat older patients with acute myeloid leukemia (AML). Recent studies, however, suggest older patients can tolerate and potentially benefit from intensive chemotherapeutic regimens. The ability to compare the utility of varying regimen intensities in AML is hindered by the lack of a standardized definition of “regimen intensity.” Methods We conducted a survey asking AML physicians which of 38 regimens they would consider intensive vs less‐intensive. Electronic medical records of 592 patients receiving many of these regimens were used to design a model characterizing regimens as intensive vs less‐intensive as identified by ≥75% physician consensus. Variables included frequency and length of hospitalizations, intensive care unit admissions, severe gastrointestinal toxicities, time to nadir, and recovery of neutrophil/platelet count. Results Physicians agreed at a rate of 75%‐100% on the assignment of degree of intensity to the majority (n = 28) of these regimens, while the level of agreement was <75% for the remaining 10 regimens (26%). Logistic regression analyses identified number and length of hospitalizations to be significantly associated with intensive regimens and count recovery with less‐intensive regimens. We created the “regimen‐intensity per count‐recovery and hospitalization” (RICH) index with an AUC of 0.87. Independent model validation yielded an AUC of 0.75. Conclusions We were able to generate a novel model that defines regimen intensity for many therapies used to treat AML. Results facilitate a future randomized study comparing intensive vs less‐intensive regimens.

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Treatment of elderly patients with acute myeloid leukemia with azacitidine results in fewer hospitalization days and infective complications but similar survival compared with intensive chemotherapy

Abstract: Compared with intensive chemotherapy in elderly patients with AML, azacitidine-based therapy is associated with similar median survival but lower number of hospitalization days and infective episodes.

Cited by 11 publications

References 37 publications

American Society of Hematology 2020 guidelines for treating newly diagnosed acute myeloid leukemia in older adults

American Society of Hematology 2020 guidelines for treating newly diagnosed acute myeloid leukemia in older adults

Efficacy of Azacitidine in De Novo and Relapsed Acute Myeloid Leukemia: A Retrospective Comparative Study

Regimen‐intensity per count‐recovery and hospitalization index: A new tool to assign regimen intensity for AML

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