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Therapeutic decision-making in elderly patients with acute myeloid leukemia: conventional intensive chemotherapy versus hypomethylating agent therapy

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Abstract

Standards of care for elderly acute myeloid leukemia (AML) patients unfit for intensive chemotherapy remain undefined. We aimed to compare outcomes of hypomethylating agent (HMA) therapy and intensive chemotherapy (IC) in elderly AML patients and identify the subgroup of patients who are eligible for HMA therapy. We reviewed data on the outcomes of 86 AML patients aged ≥ 65 years, who had undergone treatment between 2010 and 2015. These treatments included IC (25 patients, 29.1%) or therapy using HMA including azacitidine or decitabine (61 patients, 70.9%). The overall response rates were 32 and 19.7%, respectively. Median overall survival (OS) (8 vs. 8 months) and progression-free survival (PFS) (6 vs. 7 months) durations were similar in the two groups. Patients in the HMA group with less than 10% peripheral blood (PB) blasts achieved significantly better OS duration than patients in the IC group (P = 0.043). Patients in the IC group with PB blasts and bone marrow blast of ≥ 10 and ≥ 50%, respectively, achieved better PFS durations than the corresponding patients in the HMA group (P = 0.038). Multivariate analysis identified the hematologic improvement-platelet (HI-P) as an independent prognostic factor for survival in the HMA group (P = 0.005). Our results showed that HMA therapy and IC were associated with similar survival duration in elderly AML patients. This study was noteworthy because it assessed prognostic factors that would help to select elderly patients who could expect actual benefits from undergoing the different therapeutic options available, especially HMA therapy.

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Acknowledgments

We thank all centers that participated in this study.

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Authors and Affiliations

  1. Division of Hematology-Oncology, Department of Internal Medicine, School of Medicine, Medical Research Institute, Pusan National University Hospital, 179 Gudeok-ro, Seo-gu, Busan, South Korea

    Sang-Bo Oh, Sung-Woo Park, Joo-Seop Chung & Ho-Jin Shin

  2. Division of Hematology-Oncology, Busan Paik Hospital, Busan, South Korea

    Won-Sik Lee

  3. Division of Hematology-Oncology, Kosin University Gospel Hospital, Busan, South Korea

    Ho-Seop Lee

  4. Division of Hematology-Oncology, Pusan National University Yangsan Hospital, Yangsan, South Korea

    Su-Hee Cho

  5. Division of Hematology-Oncology, Ulsan University Hospital, Ulsan, South Korea

    Yoon-Suk Choi

  6. Division of Hematology-Oncology, Busan Haeundae Paik Hospital, Busan, South Korea

    Sung-Nam Lim

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  1. Sang-Bo Oh
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on behalf of the Hematology Association of South-East Korea (HASEK) study group

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Correspondence to Ho-Jin Shin.

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Conflict of interest

This work was supported by clinical research grant from Pusan National University Hospital in 2017.

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All procedures involving human participants were performed in accordance with the ethical standards of either the institutional or the national research committee, or of both, and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Oh, SB., Park, SW., Chung, JS. et al. Therapeutic decision-making in elderly patients with acute myeloid leukemia: conventional intensive chemotherapy versus hypomethylating agent therapy. Ann Hematol 96, 1801–1809 (2017). https://doi.org/10.1007/s00277-017-3104-9

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  • DOI: https://doi.org/10.1007/s00277-017-3104-9

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