Original Paper

Journal of Cancer Research and Clinical Oncology

, Volume 133, Issue 8, pp 547-553

First online:

Therapeutic strategy of untreated de novo acute myeloid leukemia in the elderly: the efficacy of continuous drip infusion with low dose cytarabine and etoposide

  • Hisashi TsurumiAffiliated withFirst Department of Internal Medicine, Gifu University Graduate School of Medicine Email author 
  • , Nobuhiro KanemuraAffiliated withFirst Department of Internal Medicine, Gifu University Graduate School of Medicine
  • , Takeshi HaraAffiliated withFirst Department of Internal Medicine, Gifu University Graduate School of Medicine
  • , Senji KasaharaAffiliated withFirst Department of Internal Medicine, Gifu University Graduate School of Medicine
  • , Toshiki YamadaAffiliated withFirst Department of Internal Medicine, Gifu University Graduate School of Medicine
  • , Michio SawadaAffiliated withFirst Department of Internal Medicine, Gifu University Graduate School of Medicine
  • , Masami OyamaAffiliated withDepartment of Internal Medicine, Ichinomiya City Kisogawa Hospital
  • , Hisataka MoriwakiAffiliated withFirst Department of Internal Medicine, Gifu University Graduate School of Medicine

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Abstract

Purpose

To evaluate the efficacy and safety of a novel low dose chemotherapy as a remission induction regimen for elderly de novo AML patients ineligible for intensive chemotherapy.

Method

Fifty consecutive patients aged 60 to 85 with untreated de novo AML were enrolled. Patients with poor PS or defined non-hematological complications were given continuous drip infusion of low dose cytarabine (Ara-C), 20 mg/body and etoposide (VP-16), 50 mg/body for 10 days (AV group). Patients without those cormobidities were given intensive induction therapy (S group). After achieving complete remission (CR), S group patients and those with improved PS in AV group received consolidation chemotherapy with intensive regimen (S-S or AV-S group), and other patients received AV regimen repeatedly (AV-AV group).

Results

Eighteen (64%; 95% confidence interval (CI), 0.47–0.82) of 28 patients in AV group and 16 (73%; 95% CI, 0.54–0.91) of 22 patients in S group achieved CR, respectively. The 1-year OS rates of the patients in the AV-AV group (n = 9), AV-S group (n = 9), and S-S group (n = 16) were 22, 81, and 78%, respectively. Although the sample size was small, no significant difference was observed for the 1-year OS rate between the AV-S and S-S groups. Regimen related death were 4 patients in S group, while no patient in AV group.

Conclusion

Therapeutic strategy consisting of remission induction using AV regimen and consolidation using intensive regimen after improving PS is beneficial in the management of elderly AML patients who have difficulty in tolerating for intensive induction chemotherapy.

Keywords

Elderly AML Low dose cytarabine Etoposide