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

Hagop Kantarjian, Farhad Ravandi, Susan O'Brien, Jorge Cortes, Stefan Faderl, Guillermo Garcia-Manero, Elias Jabbour, William Wierda, Tapan Kadia, Sherry Pierce, Jianqin Shan, Michael Keating, Emil J. Freireich

Research output: Contribution to journalArticle

Abstract

Patients ≥ 70 years of age 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 of age 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 complete response rate was 45%, 4-week mortality was 26%, and 8-week mortality was 36%. The median survival was 4.6 months, and the 1-year survival rate was 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 Eastern Cooperative Oncology Group), and elevated creatinine > 1.3 mg/dL. 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 complete response and survival rates. In summary, the prognosis of most patients (72%) ≥ 70 years of age with AML is poor with intensive chemotherapy (8-week mortality ≥ 30%; median survival < 6 months).

Original languageEnglish (US)
Pages (from-to)4422-4429
Number of pages8
JournalBlood
Volume116
Issue number22
DOIs
StatePublished - Nov 25 2010
Externally publishedYes

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Chemotherapy
Acute Myeloid Leukemia
Drug Therapy
Oncology
Mortality
Cytarabine
Creatinine
Karyotype
Survival
Survival Rate
Multivariate Analysis

ASJC Scopus subject areas

  • Biochemistry
  • Immunology
  • Hematology
  • Cell Biology

Cite this

Kantarjian, H., Ravandi, F., O'Brien, S., Cortes, J., Faderl, S., Garcia-Manero, G., ... Freireich, E. J. (2010). Intensive chemotherapy does not benefit most older patients (age 70 years or older) with acute myeloid leukemia. Blood, 116(22), 4422-4429. https://doi.org/10.1182/blood-2010-03-276485

Intensive chemotherapy does not benefit most older patients (age 70 years or older) with acute myeloid leukemia. / Kantarjian, Hagop; Ravandi, Farhad; O'Brien, Susan; Cortes, Jorge; Faderl, Stefan; Garcia-Manero, Guillermo; Jabbour, Elias; Wierda, William; Kadia, Tapan; Pierce, Sherry; Shan, Jianqin; Keating, Michael; Freireich, Emil J.

In: Blood, Vol. 116, No. 22, 25.11.2010, p. 4422-4429.

Research output: Contribution to journalArticle

Kantarjian, H, Ravandi, F, O'Brien, S, Cortes, J, Faderl, S, Garcia-Manero, G, Jabbour, E, Wierda, W, Kadia, T, Pierce, S, Shan, J, Keating, M & Freireich, EJ 2010, 'Intensive chemotherapy does not benefit most older patients (age 70 years or older) with acute myeloid leukemia', Blood, vol. 116, no. 22, pp. 4422-4429. https://doi.org/10.1182/blood-2010-03-276485
Kantarjian, Hagop ; Ravandi, Farhad ; O'Brien, Susan ; Cortes, Jorge ; Faderl, Stefan ; Garcia-Manero, Guillermo ; Jabbour, Elias ; Wierda, William ; Kadia, Tapan ; Pierce, Sherry ; Shan, Jianqin ; Keating, Michael ; Freireich, Emil J. / Intensive chemotherapy does not benefit most older patients (age 70 years or older) with acute myeloid leukemia. In: Blood. 2010 ; Vol. 116, No. 22. pp. 4422-4429.
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abstract = "Patients ≥ 70 years of age 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 of age 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 complete response rate was 45{\%}, 4-week mortality was 26{\%}, and 8-week mortality was 36{\%}. The median survival was 4.6 months, and the 1-year survival rate was 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 Eastern Cooperative Oncology Group), and elevated creatinine > 1.3 mg/dL. 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 complete response and survival rates. In summary, the prognosis of most patients (72{\%}) ≥ 70 years of age with AML is poor with intensive chemotherapy (8-week mortality ≥ 30{\%}; median survival < 6 months).",
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AU - Garcia-Manero, Guillermo

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AU - Wierda, William

AU - Kadia, Tapan

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