Elderly AML: intensive chemotherapy, decitabine offer similar OS

  • Choi EJ & al.
  • Clin Lymphoma Myeloma Leuk
  • 20 Feb 2019

  • curated by David Reilly
  • Univadis Clinical Summaries
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Takeaway

  • In elderly patients with acute myeloid leukemia (AML), induction decitabine was associated with lower response rates vs intensive chemotherapy (IC), but delivered no significant difference in OS.
  • Patients with specific cytogenetic abnormalities may be more likely to experience survival benefit with IC.

Why this matters

  • Frailty and chemoresistant disease complicate the identification of elderly patients with AML who may benefit from aggressive treatment.

Study design

  • Study to investigate outcomes in patients aged ≥65 years with newly diagnosed AML treated with induction decitabine (n=75) or IC (n=32).
  • Median age at diagnosis, 71 (range, 65-81) years.
  • 33 patients had poor-risk cytogenetics.
  • Funding: National Research Foundation of Korea; Asan Institute for Life Sciences, Korea.   

Key results

  • 65.6% overall response rate (ORR) with IC vs 26.1% with decitabine (P<.001>
  • 65.6% complete remission (CR) with IC vs 13.0% with decitabine (P<.001>
  • 14.8 months median OS with IC vs 11.0 months with decitabine (P=.124).
  • In patients harboring FLT3-ITD mutation, IC was associated with higher CR (P=.005) and longer OS (P=.025).
  • In patients with poor-risk cytogenetics other than –7del(7q), IC was associated with higher CR (P=.001), longer OS (P=.005), and longer event-free survival (P=.011).

Limitations

  • Limited sample size.

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