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Intensive chemotherapy, azacitidine, or supportive care in older acute myeloid leukemia patients: An analysis from a regional healthcare network
Author(s) -
Bories Pierre,
Bertoli Sarah,
Bérard Emilie,
Laurent Julie,
Duchayne Eliane,
Sarry Audrey,
Delabesse Eric,
BeyneRauzy Odile,
Huguet Françoise,
Récher Christian
Publication year - 2014
Publication title -
american journal of hematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.456
H-Index - 105
eISSN - 1096-8652
pISSN - 0361-8609
DOI - 10.1002/ajh.23848
Subject(s) - azacitidine , medicine , myeloid leukemia , intensive care unit , chemotherapy , intensive care , leukemia , oncology , intensive care medicine , biochemistry , gene expression , chemistry , dna methylation , gene
We assessed in a French regional healthcare network the distribution of treatments, prognostic factors, and outcome of 334 newly diagnosed acute myeloid leukemia patients aged 60 years or older over a 4‐year period of time (2007–2010). Patients were selected in daily practice for intensive chemotherapy ( n = 115), azacitidine ( n = 95), or best supportive care ( n = 124). In these three groups, median overall survival was 18.9, 11.3, and 1.8 months, respectively. In the azacitidine group, multivariate analysis showed that overall survival was negatively impacted by higher age ( P = 0.010 for one unit increase), unfavorable cytogenetics ( P = 0.001), lymphocyte count <0.5 G/L ( P = 0.015), and higher lactate dehydrogenase level ( P = 0.005 for one unit increase). We compared the survival of patients treated by azacitidine versus intensive chemotherapy and best supportive care using time‐dependent analysis and propensity score matching. Patients treated by intensive chemotherapy had a better overall survival compared with those treated by azacitidine from 6 months after diagnosis, whereas patients treated by azacitidine had a better overall survival compared with those treated by best supportive care from 1 day after diagnosis. This study of “real life” practice shows that there is a room for low intensive therapies such as azacitidine in selected elderly acute myeloid leukemia patients. Am. J. Hematol. 89:E244–E252, 2014. © 2014 Wiley Periodicals, Inc.