Impact of remission induction chemotherapy on survival in older adults with acute myeloid leukemia

Department of Hematologic Oncology and Blood Disorders, Cleveland Clinic Taussig Cancer Center, Cleveland, Ohio 44195, USA.
Cancer (Impact Factor: 4.89). 10/2007; 110(8):1752-9. DOI: 10.1002/cncr.22976
Source: PubMed

ABSTRACT Significant controversy surrounds the use of remission induction chemotherapy (IC) in older adults with acute myeloid leukemia (AML). Earlier clinical trials have yielded conflicting results and possibly a minor survival benefit, often offset by a longer hospitalization time.
To evaluate the role of IC in patients with AML, a case control study of patients 60 years or older treated at the Cleveland Clinic Taussig Cancer Center between 1997 and 2005 was conducted. Forty-four patients who did not receive IC were matched by a propensity analysis to 138 patients who received an anthracycline-based regimen.
The unadjusted median survival of patients who did not receive IC was 53 days, compared with 197 days (P < .001) for those who did. After further adjusting for age, gender, race, leukocyte count at presentation, AML cytogenetics, history of prior hematologic disorder, and assessing for comorbidities, not receiving IC was still associated with worse survival (hazards ratio of 1.88; 95% confidence interval, 1.15-3.05 [P = .01]). Additional predictors of poor outcomes in older adults with AML included higher leukocyte count at presentation, poor-risk cytogenetics, and African-American race (compared with Caucasians).
The study suggests improved outcomes in older adults with AML who undergo remission induction therapy.

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    • "This trial noted a significant median survival benefit of only 10 weeks for patients receiving remission induction therapy.26 A more recent case-control study showed a survival advantage for giving intensive chemotherapy compared to best supportive care or low-dose approaches of 197 days vs 53 days (hazard ration [HR] 1.88, p = 0.01).27 "
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