Skip to main content
SpringerLink
Log in

Role of induction and consolidation chemotherapy in elderly acute myeloid leukemia patients

  • Original Article
  • Published:
International Journal of Hematology Aims and scope Submit manuscript

Abstract

The present study sought to elucidate the role of induction and consolidation therapy in elderly patients. We retrospectively collected data of 477 patients who were aged over 60 years at the time of acute myeloid leukemia (AML) diagnosis. The median overall survival (OS) was 339 days in the induction group (n = 266) and 86 days in the best supportive care group (n = 211) (P < 0.001). In the induction group, the complete remission (CR) rate was 58.3 %, and treatment-related death was 15.4 %. Successful induction was related to good performance [Eastern Cooperative Oncology Group (ECOG <2)] [hazard ratio (HR) 3.215; P = 0.002]. Mortality correlated with failure to achieve CR (HR 4.059; P < 0.001) and poor performance status (ECOG >2) (HR 2.731; P = 0.035). In CR patients, poor karyotype and absence of consolidation (HR 2.313; P = 0.003) correlated with mortality. More than one cycle of consolidation was associated with better OS (P < 0.001). Lack of salvage therapy was associated with mortality in patients who did not achieve CR (HR 3.223; P = 0.005). Intensive induction in patients with good performance and >1 cycle of consolidation after CR may be the best strategy for improving OS in elderly AML patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. SEER. Cancer statistics review 1975–2007. 2010.

  2. Juliusson G, Antunovic P, Derolf A, Lehmann S, Möllgård L, Stockelberg D, et al. Age and acute myeloid leukemia: real world data on decision to treat and outcomes from the Swedish Acute Leukemia Registry. Blood. 2009;113:4179–87.

    Article  CAS  PubMed  Google Scholar 

  3. Grimwade D, Walker H, Harrison G, Oliver F, Chatters S, Harrison CJ, et al. The predictive value of hierarchical cytogenetic classification in older adults with acute myeloid leukemia (AML): analysis of 1065 patients entered into the United Kingdom Medical Research Council AML11 trial. Blood. 2001;98:1312–20.

    Article  CAS  PubMed  Google Scholar 

  4. Wilson CS, Davidson GS, Martin SB, Andries E, Potter J, Harvey R, et al. Gene expression profiling of adult acute myeloid leukemia identifies novel biologic clusters for risk classification and outcome prediction. Blood. 2006;108:685–96.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  5. Leith CP, Kopecky KJ, Chen IM, Eijdems L, Slovak ML, McConnell TS, et al. Frequency and clinical significance of the expression of the multidrug resistance proteins MDR1/P-glycoprotein, MRP1, and LRP in acute myeloid leukemia: a Southwest Oncology Group Study. Blood. 1999;94:1086–99.

    CAS  PubMed  Google Scholar 

  6. Appelbaum FR, Gundacker H, Head DR, Slovak ML, Willman CL, Godwin JE, et al. Age and acute myeloid leukemia. Blood. 2006;107:3481–5.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  7. Löwenberg B, Ossenkoppele GJ, van Putten W, Schouten HC, Graux C, Ferrant A, et al. High-dose daunorubicin in older patients with acute myeloid leukemia. N Engl J Med. 2009;361:1235–48.

    Article  PubMed  Google Scholar 

  8. Oran B, Weisdorf DJ. Survival for older patients with acute myeloid leukemia: a population-based study. Haematologica. 2012;97:1916–24.

    Article  PubMed Central  PubMed  Google Scholar 

  9. Dombret H, Chastang C, Fenaux P, Reiffers J, Bordessoule D, Bouabdallah R, et al. A controlled study of recombinant human granulocyte colony-stimulating factor in elderly patients after treatment for acute myelogenous leukemia. AML Cooperative Study Group. N Engl J Med. 1995;332:1678–83.

    Article  CAS  PubMed  Google Scholar 

  10. Stone RM, Berg DT, George SL, Dodge RK, Paciucci PA, Schulman P, et al. Granulocyte-macrophage colony-stimulating factor after initial chemotherapy for elderly patients with primary acute myelogenous leukemia. Cancer and Leukemia Group B. N Engl J Med. 1995;332:1671–7.

    Article  CAS  PubMed  Google Scholar 

  11. Malfuson JV, Etienne A, Turlure P, de Revel T, Thomas X, Contentin N, et al. Risk factors and decision criteria for intensive chemotherapy in older patients with acute myeloid leukemia. Haematologica. 2008;93:1806–13.

    Article  CAS  PubMed  Google Scholar 

  12. Wheatley K, Brookes CL, Howman AJ, Goldstone AH, Milligan DW, Prentice AG, et al. Prognostic factor analysis of the survival of elderly patients with AML in the MRC AML11 and LRF AML14 trials. Br J Haematol. 2009;145:598–605.

    Article  PubMed  Google Scholar 

  13. Kantarjian H, O’Brien S, Cortes J, Giles F, Faderl S, Jabbour E, et al. Results of intensive chemotherapy in 998 patients age 65 years or older with acute myeloid leukemia or high-risk myelodysplastic syndrome: predictive prognostic models for outcome. Cancer. 2006;106:1090–8.

    Article  PubMed  Google Scholar 

  14. Slovak ML, Kopecky KJ, Cassileth PA, Harrington DH, Theil KS, Mohamed A, et al. Karyotypic analysis predicts outcome of preremission and postremission therapy in adult acute myeloid leukemia: a Southwest Oncology Group/Eastern Cooperative Oncology Group Study. Blood. 2000;96:4075–83.

    CAS  PubMed  Google Scholar 

  15. Cheson BD, Bennett JM, Kopecky KJ, Büchner T, Willman CL, Estey EH, et al. Revised recommendations of the International Working Group for Diagnosis, Standardization of Response Criteria, Treatment Outcomes, and Reporting Standards for Therapeutic Trials in Acute Myeloid Leukemia. J Clin Oncol. 2003;21:4642–9.

    Article  PubMed  Google Scholar 

  16. Löwenberg B, Zittoun R, Kerkhofs H, Jehn U, Abels J, Debusscher L, et al. On the value of intensive remission-induction chemotherapy in elderly patients of 65 + years with acute myeloid leukemia: a randomized phase III study of the European Organization for Research and Treatment of Cancer Leukemia Group. J Clin Oncol. 1989;7:1268–74.

    PubMed  Google Scholar 

  17. Baz R, Rodriguez C, Fu AZ, Jawde RA, Kalaycio M, Advani A, et al. Impact of remission induction chemotherapy on survival in older adults with acute myeloid leukemia. Cancer. 2007;110:1752–9.

    Article  CAS  PubMed  Google Scholar 

  18. Pulsoni A, Pagano L, Latagliata R, Casini M, Cerri R, Crugnola M, et al. Survival of elderly patients with acute myeloid leukemia. Haematologica. 2004;89:296–302.

    PubMed  Google Scholar 

  19. Roboz GJ, Wissa U, Ritchie EK, Gergis U, Mayer S, Scandura JM, et al. Are low-intensity induction strategies better for older patients with acute myeloid leukemia? Leuk Res. 2012;36:407–12.

    Article  PubMed Central  PubMed  Google Scholar 

  20. Kantarjian H, Ravandi F, O’Brien S, Cortes J, Faderl S, Garcia Manero G, et al. Intensive chemotherapy does not benefit most older patients (age 70 years or older) with acute myeloid leukemia. Blood. 2010;116:4422–9.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  21. Tsimberidou AM, Kantarjian HM, Wen S, O’Brien S, Cortes J, Wierda WG, et al. The prognostic significance of serum beta2 microglobulin levels in acute myeloid leukemia and prognostic scores predicting survival: analysis of 1,180 patients. Clin Cancer Res. 2008;14:721–30.

    Article  CAS  PubMed  Google Scholar 

  22. Gupta V, Chun K, Yi QL, Minden M, Schuh A, Wells R, et al. Disease biology rather than age is the most important determinant of survival of patients > or = 60 years with acute myeloid leukemia treated with uniform intensive therapy. Cancer. 2005;103:2082–90.

    Article  PubMed  Google Scholar 

  23. Rollig C, Thiede C, Gramatzki M, Aulitzky W, Bodenstein H, Bornhauser M, et al. A novel prognostic model in elderly patients with acute myeloid leukemia: results of 909 patients entered into the prospective AML96 trial. Blood. 2010;116:971–8.

    Article  PubMed  Google Scholar 

  24. Koren Michowitz M, Sato Otsubo A, Nagler A, Haferlach T, Ogawa S, Koeffler HP. Older patients with normal karyotype acute myeloid leukemia have a higher rate of genomic changes compared to young patients as determined by SNP array analysis. Leuk Res. 2012;36:467–73.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  25. Goldstone AH, Burnett AK, Wheatley K, Smith AG, Hutchinson RM, Clark RE. Attempts to improve treatment outcomes in acute myeloid leukemia (AML) in older patients: the results of the United Kingdom Medical Research Council AML11 trial. Blood. 2001;98:1302–11.

    Article  CAS  PubMed  Google Scholar 

  26. Burnett AK, Hills RK, Milligan DW, Goldstone AH, Prentice AG, McMullin MF, et al. Attempts to optimize induction and consolidation treatment in acute myeloid leukemia: results of the MRC AML12 trial. J Clin Oncol. 2010;28:586–95.

    Article  CAS  PubMed  Google Scholar 

Download references

Conflict of interest

All authors have no financial conflict of interest with company for this investigation to declare.

Author information

Authors and Affiliations

  1. Division of Hematology, Department of Internal Medicine, Yonsei University College of Medicine, Severance Hospital, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea

    Soo-Jeong Kim, June-Won Cheong & Yoo Hong Min

  2. Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

    Dae-Young Kim, Je-Hwan Lee & Kyoo-Hyung Lee

  3. Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, Hwasun, Jeollanam-do, Republic of Korea

    Yeo-Kyeoung Kim & Hyeong-Joon Kim

  4. Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea

    Ik-Chan Song & Deog-Yeon Jo

  5. Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea

    Jeong-Ok Lee & Soo-Mee Bang

  6. Division of Hematology and Oncology, Department of Internal Medicine, Gachon University Gil Hospital, Incheon, Republic of Korea

    Jinny Park & Jae Hoon Lee

  7. Department of Hemato/Oncology, College of Medicine, Inje University, Busan, Republic of Korea

    Won-Sik Lee & Young-Don Joo

  8. Department of Hematology-Oncology, College of Medicine, Kyung Hee University Seoul, Seoul, Republic of Korea

    Chi Hoon Maeng & Hwi-Joong Yoon

  9. Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Republic of Korea

    Na-Ri Lee & Jae-Yong Kwak

  10. Division of Hematology-Oncology, Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Korea

    Kyoung Ha Kim & Jong-Ho Won

  11. Division of Hematology-Oncology, Hallym University Medical Center, Hallym University College of Medicine, Seoul, Republic of Korea

    Bo Ram Han & Dae Young Zang

  12. Department of Hematology and Medical Oncology, Kyungpook National University Hospital, Daegu, Republic of Korea

    Joon Ho Moon & Sang Kyun Sohn

  13. Department of Hematology-Oncology, Deagu Catholic Medical Center, Catholic University of Daegu School of Medicine, Deagu, Korea

    Sung Hwa Bae & Hun Mo Ryoo

  14. Division of Hematology-Oncology, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea

    Sung-Yong Kim & Mark Hong Lee

Authors
  1. Soo-Jeong Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. June-Won Cheong
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Dae-Young Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Je-Hwan Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kyoo-Hyung Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yeo-Kyeoung Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Hyeong-Joon Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Ik-Chan Song
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Deog-Yeon Jo
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Jeong-Ok Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Soo-Mee Bang
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Jinny Park
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Jae Hoon Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Won-Sik Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Young-Don Joo
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Chi Hoon Maeng
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Hwi-Joong Yoon
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. Na-Ri Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  19. Jae-Yong Kwak
    View author publications

    You can also search for this author in PubMed Google Scholar

  20. Kyoung Ha Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  21. Jong-Ho Won
    View author publications

    You can also search for this author in PubMed Google Scholar

  22. Bo Ram Han
    View author publications

    You can also search for this author in PubMed Google Scholar

  23. Dae Young Zang
    View author publications

    You can also search for this author in PubMed Google Scholar

  24. Joon Ho Moon
    View author publications

    You can also search for this author in PubMed Google Scholar

  25. Sang Kyun Sohn
    View author publications

    You can also search for this author in PubMed Google Scholar

  26. Sung Hwa Bae
    View author publications

    You can also search for this author in PubMed Google Scholar

  27. Hun Mo Ryoo
    View author publications

    You can also search for this author in PubMed Google Scholar

  28. Sung-Yong Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  29. Mark Hong Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  30. Yoo Hong Min
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

The Korean Society of Hematology AML/MDS Working Party

Corresponding author

Correspondence to Yoo Hong Min.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kim, SJ., Cheong, JW., Kim, DY. et al. Role of induction and consolidation chemotherapy in elderly acute myeloid leukemia patients. Int J Hematol 100, 141–151 (2014). https://doi.org/10.1007/s12185-014-1617-8

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12185-014-1617-8

Keywords

Search

Navigation