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Outcomes of previously untreated elderly patients with AML: a propensity score-matched comparison of clofarabine vs. FLAG

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Abstract

The 5-year overall survival (OS) in patients ≥ 60 years old with acute myeloid leukemia (AML) remains < 10%. Clofarabine-based induction (CLO) provides an alternative to low-intensity therapy (LIT) and palliative care for this population, but supporting data are conflicted. Recently, our institution adopted the FLAG regimen (fludarabine, cytarabine, and granulocyte colony-stimulating factor) based on data reporting similar outcomes to CLO in elderly patients with AML unable to tolerate anthracycline-based induction. We retrospectively analyzed the efficacy and safety of patients ≥ 60 years old with AML treated with FLAG or CLO over the past 10 years. We performed a propensity score match that provided 32 patients in each group. Patients treated with FLAG had a higher CR/CRi rate (65.6 vs. 37.5%, P = 0.045) and OS (7.9 vs. 2.8 months, P = 0.085) compared to CLO. Furthermore, FLAG was better tolerated with significantly less grade 3/4 toxicities and a shorter duration of neutropenia (18.5 vs. 30 days, P = 0.002). Finally, we performed a cost analysis that estimated savings to be $30,000–45,000 per induction with FLAG. Our study supports the use of FLAG both financially and as an effective, well-tolerated high-dose treatment regimen for elderly patients with AML. No cases of cerebellar neurotoxicity occurred.

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Authors and Affiliations

  1. Department of Pharmacy Services and Clinical Sciences, Michigan Medicine and University of Michigan College of Pharmacy, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA

    Gianni B. Scappaticci, Bernard L. Marini, Victoria R. Nachar, Vera Vulaj & Anthony J. Perissinotti

  2. Department of Internal Medicine and Division of Hematology and Oncology, Michigan Medicine and University of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA

    James R. Uebel, Ashley Crouch, Dale L. Bixby & Moshe Talpaz

  3. Ann Arbor, USA

    Anthony J. Perissinotti

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  1. Gianni B. Scappaticci
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Contributions

Study design and concept: GBS, BLM, DLB, AJP. Collected data: GBS, VRN, JRU. Statistical analysis: GBS. Wrote the manuscript: GBS, BLM, AJP. Reviewed the manuscript and provided editorial input: all authors.

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Scappaticci, G.B., Marini, B.L., Nachar, V.R. et al. Outcomes of previously untreated elderly patients with AML: a propensity score-matched comparison of clofarabine vs. FLAG. Ann Hematol 97, 573–584 (2018). https://doi.org/10.1007/s00277-017-3217-1

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