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Intensive chemotherapy and reduced‐intensity allogeneic hematopoietic stem cell transplantation for acute myeloid leukemia in elderly patients
Author(s) -
Jackson Kathryn,
Kennedy Glen,
Mollee Peter,
Marlton Paula,
Morris Kirk
Publication year - 2014
Publication title -
asia‐pacific journal of clinical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.73
H-Index - 29
eISSN - 1743-7563
pISSN - 1743-7555
DOI - 10.1111/ajco.12188
Subject(s) - medicine , myeloid leukemia , chemotherapy , hematopoietic stem cell transplantation , induction chemotherapy , transplantation , incidence (geometry) , cumulative incidence , retrospective cohort study , refractory (planetary science) , acute leukemia , leukemia , surgery , oncology , physics , astrobiology , optics
Aims Acute myeloid leukemia ( AML ) incidence increases with age, yet treatment of elderly patients has reduced efficacy compared with younger patients and is often poorly tolerated. This retrospective study assessed the outcomes of older patients with AML treated with intensive chemotherapy with or without allogeneic hematopoietic stem cell transplantation ( HSCT ). Methods We identified all adult patients ≥60 years with newly diagnosed AML treated with induction chemotherapy at our institutions between F ebruary 1999 and J uly 2011. Institutional databases and medical records were used to collect information on baseline characteristics, chemotherapy protocols, response to therapy, relapse‐free survival ( RFS ) and overall survival ( OS ). Results Three hundred and forty‐five patients ≥60 years were diagnosed with AML , including 172 patients (49.9%) who received intensive induction chemotherapy. The median age of intensively treated patients was 66 years (range 60–83 years). Responses to one to two cycles of induction chemotherapy were complete remission ( CR ) in 70.3% of patients, refractory disease in 15.1% and induction death in 14.5%. At a median follow‐up of 22 months for survivors, intensive induction chemotherapy resulted in 3‐year RFS of 20.2%, and 3‐year OS of 24.0%. Seventeen patients (14.0% of patients in CR 1) proceeded to allogeneic HSCT in first remission. These patients experienced 3‐year RFS of 63.5% and 3‐year OS of 77.5%. Conclusion Intensive induction chemotherapy for newly diagnosed AML in older patients is feasible and effective in a proportion of patients, and those selected for allogeneic transplantation in CR 1 may experience particularly favorable survival outcomes.