Intensive chemotherapy and reduced-intensity allogeneic hematopoietic stem cell transplantation for acute myeloid leukemia in elderly patients

Jackson, Kathryn, Kennedy, Glen, Mollee, Peter, Marlton, Paula and Morris, Kirk (2014) Intensive chemotherapy and reduced-intensity allogeneic hematopoietic stem cell transplantation for acute myeloid leukemia in elderly patients. Asia-Pacific Journal of Clinical Oncology, 10 3: 246-254. doi:10.1111/ajco.12188


Author Jackson, Kathryn
Kennedy, Glen
Mollee, Peter
Marlton, Paula
Morris, Kirk
Title Intensive chemotherapy and reduced-intensity allogeneic hematopoietic stem cell transplantation for acute myeloid leukemia in elderly patients
Journal name Asia-Pacific Journal of Clinical Oncology   Check publisher's open access policy
ISSN 1743-7563
1743-7555
Publication date 2014-09
Sub-type Article (original research)
DOI 10.1111/ajco.12188
Open Access Status Not yet assessed
Volume 10
Issue 3
Start page 246
End page 254
Total pages 9
Place of publication Chichester, West Sussex United Kingdom
Publisher Wiley-Blackwell Publishing
Language eng
Formatted abstract
Aims

Acute myeloid leukemia (AML) incidence increases with age, yet treatment of elderly patients has reduced efficacy compared with younger patients and is often poorly tolerated. This retrospective study assessed the outcomes of older patients with AML treated with intensive chemotherapy with or without allogeneic hematopoietic stem cell transplantation (HSCT).

Methods

We identified all adult patients ≥60 years with newly diagnosed AML treated with induction chemotherapy at our institutions between February 1999 and July 2011. Institutional databases and medical records were used to collect information on baseline characteristics, chemotherapy protocols, response to therapy, relapse-free survival (RFS) and overall survival (OS).

Results

Three hundred and forty-five patients ≥60 years were diagnosed with AML, including 172 patients (49.9%) who received intensive induction chemotherapy. The median age of intensively treated patients was 66 years (range 60–83 years). Responses to one to two cycles of induction chemotherapy were complete remission (CR) in 70.3% of patients, refractory disease in 15.1% and induction death in 14.5%. At a median follow-up of 22 months for survivors, intensive induction chemotherapy resulted in 3-year RFS of 20.2%, and 3-year OS of 24.0%. Seventeen patients (14.0% of patients in CR1) proceeded to allogeneic HSCT in first remission. These patients experienced 3-year RFS of 63.5% and 3-year OS of 77.5%.

Conclusion

Intensive induction chemotherapy for newly diagnosed AML in older patients is feasible and effective in a proportion of patients, and those selected for allogeneic transplantation in CR1 may experience particularly favorable survival outcomes.
Keyword Acute myeloid leukemia
Elderly
Older
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collection: School of Medicine Publications
 
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