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Treatment patterns and comparative analysis of non-intensive regimens in elderly acute myeloid leukemia patients—a real-world experience from India

  • Govind B. Kanakasetty
  • Chethan REmail author
  • Lakshmaiah K C
  • Lokanatha Dasappa
  • Linu Abraham Jacob
  • Suresh Babu M C
  • Lokesh K N
  • Rudresha Antapura Haleshappa
  • Rajeev L K
  • Smitha Carol Saldanha
  • Koppaka Deepak
  • Patidar Rajesh
  • Vikas Asati
Original Article
  • 23 Downloads

Abstract

Elderly patients with acute myeloid leukemia have a poor prognosis. Data from developing countries is sparse in the literature. In this retrospective study, 402 patients aged ≥ 60 years, diagnosed between Jan 2013 and Dec 2017, were analyzed for treatment patterns and survival. Median age of the whole cohort was 68 years (range 61–84). A total of 213 patients (53.3%) refused care; 188 patients (46.7%) received either BSC, LDAC, or HMA. Survival (in months) was 3.9, 6.4, and 1.2 with LDAC, HMA, and BSC, respectively. One-year survival was 17.2% and 6% with HMA and LDAC, respectively (P = 0.02). Overall response rate (ORR) did not differ between HMA and LDAC group (p = 0.12). HMA cohort had higher complete responses (20.6% vs 7.4%, p = 0.02), stable disease (32.7% vs 13.5%, p = 0.02), and transfusion independence (TI) (46.5% vs 22.2%, p = 0.01). Survival did not differ between the groups if the patients achieved ORR (12.3 vs 9.8 p = 0.2) or TI (11.6 vs 6.4 p = 0.2). Stable disease with HMA led to longer survival (8.1 vs 5.3 p = 0.01). HMAs were more effective than LDAC irrespective of cytogenetic risk category and blasts, of note HMAs improved survival of poor risk patients (5.6 vs 2.9 p = 0.004). HMA treatment (HR = 0.48; 95% 0.29–0.79, p = 0.004) and transfusion independence (HR = 0.2; 95% 0.1–0.3, p = 0.0001) predicted survival in multivariate analysis. Neutropenia and febrile neutropenia were frequent in HMA. Thrombocytopenia was the common adverse event with LDAC. Novel and cost-effective drugs are essential to improve the prognosis of these patients.

Keywords

LDAC-low dose cytarabine HMA-hypomethylating agents AML-acute myeloid leukemia TI-transfusion independence 

Notes

Compliance with ethical standards

The study was approved by the local ethics committee. Consent was obtained from all the patients before the treatment.

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Govind B. Kanakasetty
    • 1
  • Chethan R
    • 1
    Email author
  • Lakshmaiah K C
    • 1
  • Lokanatha Dasappa
    • 1
  • Linu Abraham Jacob
    • 1
  • Suresh Babu M C
    • 1
  • Lokesh K N
    • 1
  • Rudresha Antapura Haleshappa
    • 1
  • Rajeev L K
    • 1
  • Smitha Carol Saldanha
    • 1
  • Koppaka Deepak
    • 1
  • Patidar Rajesh
    • 1
  • Vikas Asati
    • 1
  1. 1.Department of Medical OncologyKidwai Memorial Institute of OncologyBangaloreIndia

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