Acute myeloblastic leukaemias in adult patients: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

Department of Medical Oncology, Inselspital and University of Bern, Switzerland.
Annals of Oncology (Impact Factor: 7.04). 05/2010; 21 Suppl 5(suppl 5):v158-61. DOI: 10.1093/annonc/mdq179
Source: PubMed
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    • "The European LeukemiaNet [1], European Society of Medical Oncology [2], and National Comprehensive Cancer Network (US) [3] recently indicated that management of patients aged ≥60 years with acute myeloid leukemia (AML) should be guided by performance status and presence of comorbidities. Until recently, treatment approaches had proven difficult in older patients. "
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    ABSTRACT: Compared with younger patients, older adults with acute myeloid leukemia (AML) generally have poorer survival outcomes and less benefit from clinical trials. A recent phase 3 trial demonstrated a trend toward improved overall survival (OS) with decitabine, a hypomethylating agent, compared with treatment choice of either cytarabine or supportive care (7.7 months, 95% CI: 6.2-9.2 vs 5.0 months, 95% CI: 4.3-6.3, respectively) in older adults with newly diagnosed AML. The current analyses investigated prognostic factors for outcomes in this trial and examined OS and responses in prespecified subgroups. A multivariate Cox proportional hazards model was used to investigate effects of demographic and baseline characteristics, including age, sex, cytogenetic risk, AML type, ECOG Performance Status, geographic region, bone marrow blasts, platelets, and white blood cells on OS, based on mature data. Similar analyses were conducted with a logistic regression model to predict response rates. Prespecified subgroup analyses were performed for OS and response rates, also using mature data. identifier is NCT00260832. Patient characteristics that appeared to negatively influence OS included more advanced age (hazard ratio [HR] 1.560 for >=75 vs <70 years; p = 0.0010), poorer performance status at baseline (HR 0.771 for 0 or 1 vs 2; p = 0.0321), poor cytogenetics (HR 0.699 for intermediate vs poor; p = 0.0010), higher bone marrow blast counts (HR 1.355 for >50% vs <=50%; p = 0.0045), low baseline platelet counts (HR 0.775 for each additional 100 x 109/L; p = 0.0015), and high white blood cell counts (HR 1.256 for each additional 25 x 109/L; p = 0.0151). Regarding geographic regions, patients from Western Europe had the longest median OS. Response rates favored decitabine for all subgroups investigated, including patients >=75 years (odds ratio 5.94, p = 0.0006). Response to decitabine in AML is associated with known prognostic factors related to both patient demographics and disease characteristics.Trial registration: identifier NCT00260832.
    Full-text · Article · Feb 2014 · BMC Cancer
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    • "By contrast, the prognosis of patients with MDS is generally poor due to disease progression, deterioration, and increasing transfusion dependence [38]. The presence of comorbid conditions (e.g., diabetes, coronary heart disease, or chronic pulmonary obstructive disease) which are increasingly prevalent among elderly populations also complicate the management of MDS and contribute to poor risk among these patients [39]. As such, HRQOL may be expected to deteriorate among MDS populations over time, independent of the form of ICT that is received by the patient. "
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    ABSTRACT: Treatment of iron overload using deferoxamine (DFO) is associated with significant deficits in patients' health-related quality of life (HRQOL) and low treatment satisfaction. The current article presents patient-reported HRQOL, satisfaction, adherence, and persistence data from β-thalassemia (n = 274) and myelodysplastic syndrome (MDS) patients (n = 168) patients participating in the Evaluation of Patients' Iron Chelation with Exjade (EPIC) study (NCT00171821); a large-scale 1-year, phase IIIb study investigating the efficacy and safety of the once-daily oral iron chelator, deferasirox. HRQOL and satisfaction, adherence, and persistence to iron chelation therapy (ICT) data were collected at baseline and end of study using the Medical Outcomes Short-Form 36-item Health Survey (SF-36v2) and the Satisfaction with ICT Questionnaire (SICT). Compared to age-matched norms, β-thalassemia and MDS patients reported lower SF-36 domain scores at baseline. Low levels of treatment satisfaction, adherence, and persistence were also observed. HRQOL improved following treatment with deferasirox, particularly among β-thalassemia patients. Furthermore, patients reported high levels of satisfaction with deferasirox at end of study and greater ICT adherence, and persistence. Findings suggest deferasirox improves HRQOL, treatment satisfaction, adherence, and persistence with ICT in β-thalassemia and MDS patients. Improving such outcomes is an important long-term goal for patients with iron overload.
    Full-text · Article · Aug 2012 · Anemia
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    ABSTRACT: 100 Definición Grupo heterogéneo de leucemias que se presen-tan en precursores de células mieloides, eritroides, megacariocíticos y monocíticos. Resultan de una transformación clonal de precursores hematopo-yéticos a través de la adquisición de rearreglos cro-mosómicos y múltiples mutaciones genéticas (1). Incidencia Cinco a 8 casos por cada 100,000 individuos al año. Seis mil quinientos niños y adolescentes por año, en Esta-dos Unidos. No hay diferencia entre varones y mujeres, ni en población blanca o negra. Mayor incidencia en población latinoamericana. La incidencia incrementa con la edad, exposición a quimioterapia, radioterapia y benceno (1-3). La mortalidad se estima en cuatro a seis casos por 100,000 habitantes por año. Algunas condi-ciones que predisponen al desarrollo de leucemia aguda mieloblástica (LAM) son: síndrome de Down; síndro-mes hereditarios y adquiridos de falla medular, donde destacan: la anemia aplásica; el síndrome mielodisplá-sico (SMD) y la hemoglobinuria paroxística nocturna (HPN). Algunos síndromes mieloproliferativos (SMP) podrán evolucionar a ciertas formas de LAM (4-6).
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