Backround: Most of patients with acute myeloid leukaemia (AML) are elderly and older age is an negative prognostic factor for AML. There is no consensus about treatment of elderly patients with AML. In this study, we evaluated intensive treatment with cytosine arabinoside and idarubicine versus azacitidine treatment. Primary objectives were evaluation of disease free (DFS) and overall survival (OS), the rate of complete remission and the remission duration.

Methods: 45 patients with AML were evaluated retrospectively. We examined peripheral blood smear, bone marrow aspirate and trephine, immunophenotyping and cytogenetic analysis, biochemical evaluation of renal and liver function and coagulation profile in pre-treatment period. Intensive treatment consisted of cytosine arabinoside 200 mg/m2/day for 7 days and idarubicin 12 mg/m2/ for 3 days. Bone marrow examination was done between 14-28 days for intensive treatment and 2-6 cyclus for azacitidine treatment. Consolidation treatment (1-3) was done after intensive treatment if the patients were remission. All patients were ≤ECOG 2. Growth factors were not routinely administered before, during or after chemotherapy. Statistical analyses, differences in baseline characteristics between groups were analyzed using the Student's t-test for continuous variables and differences in OS between groups were then analyzed using the likelihood ratio or log-rank tests.

Table 1.

The main properties of patients with elderly AML

Treatment
arm		Mean ageSex
M/F		Leucocyte
mean		Hb
gr/dl		FAB
(n)		MDS
history(n)		LDHComplete remission
Total 73±9 26/19 34.029±6870 8.53±1,2 M0:15, M1:6, M2:15,M4:4,M5:2 Yes:21
No:24 		276±151 15 
Intensive 72±7 18/10 44.176±12390 6.91±2 M0:6, M1:4, M2:12, M4:3, M5:1 yes: 14 299±101 13 
Azacitidine 74±8 8/9 31.289±4013 8,95±1.6 M0:9, M1:2, M2:3, M4:1, M5:1 yes:7 256±72 2 
Treatment
arm		Mean ageSex
M/F		Leucocyte
mean		Hb
gr/dl		FAB
(n)		MDS
history(n)		LDHComplete remission
Total 73±9 26/19 34.029±6870 8.53±1,2 M0:15, M1:6, M2:15,M4:4,M5:2 Yes:21
No:24 		276±151 15 
Intensive 72±7 18/10 44.176±12390 6.91±2 M0:6, M1:4, M2:12, M4:3, M5:1 yes: 14 299±101 13 
Azacitidine 74±8 8/9 31.289±4013 8,95±1.6 M0:9, M1:2, M2:3, M4:1, M5:1 yes:7 256±72 2 
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Results: Total patient number were 45 and they were ≥ 65 years (yrs). Male/female ratio was 29/16. Two patients rejected leukemia treatment. One patient were not evaluated for treatment response. Intensive arm consisted of 26 patients and azacitidine arm 16 patients. Disease free survival and overall survival for intensive arm and azacitidine arm were 12,1±9,4, 16,7±22,4, respectively. The most importance factors were leucocyte counts, hb level.

Picture 1-2: Disease free survival and overall survival for intensive arm and azacitidine arm

Conclusions: These results showed that intensive treatment is more effective than azacitidine in elderly AML patients with ECOC≤2. There is need for large studies which include higher number of patients with AML in order to evaluate efficiency of intensive treatment.

Figure 1.
Figure 1.
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Figure 2.
Figure 2.
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Disclosures

No relevant conflicts of interest to declare.

Topics:
azacitidine, leukemia, myelocytic, acute, older adult, complete remission, cytarabine, disease remission, blood coagulation tests, bone marrow aspiration, bone marrow examination, chemotherapy regimen

Author notes

*

Asterisk with author names denotes non-ASH members.

© 2015 by The American Society of Hematology
2015
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