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


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.

  • Source
    • "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 "
    [Show abstract] [Hide abstract]
    ABSTRACT: As the overall prognosis and treatment response rate to standard chemotherapy for acute myeloid leukemia (AML) remains poor in the older adult population, there is a need for more effective therapeutic agents with lower toxicity profiles that can be offered to these patients. Gemtuzumab ozogamicin (GO) is an anti-CD33 monoclonal antibody that was approved by the US Food and Drug Administration for use as monotherapy in patients 60 years of age and older with relapsed AML. GO consists of a humanized anti-CD33 antibody (hP67.6) which is linked to N-acetyl-gamma calicheamicin 1,2-dimethyl hydrazine dichloride. Once the antibody attaches to the surface antigen, it is rapidly internalized. Calicheamicin, a potent enediyne, is subsequently released and acts as a cytotoxic anti-tumor agent. In this population, GO has an acceptable toxicity and yields response rates approaching 30%. The efficacy of GO as monotherapy and in combination therapy for treatment of both de novo and relapsed AML continues to be investigated.
    Full-text · Article · Feb 2009 · Clinical Interventions in Aging
    • "The low dose ARA-C treatments produce CR of 18–34% and a median survival of <6 months [5] [6]. For elderly patients with AML standard dose ARA- C was demonstrated to be more effective than low dose ARA-C, but median survival was <7 months [7]. There is a need to improve the effectiveness of chemotherapy in elderly patients with AML, especially those who cannot tolerate standard chemotherapy. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Cytosine arabinoside (Ara-C) is a very potent inhibitor of DNA synthesis in mammalian cells. This inhibition does not appear to be due to the direct inhibition of DNA polymerase by Ara-CTP (triphosphate of Ara-C) because it is a very weak competitive inhibitor of this enzyme. The inhibition of DNA synthesis appears to be due to the incorporation of Ara-C into DNA producing chain termination of polydeoxynucleotide elongation.
    No preview · Article · Jan 1982 · Medical and Pediatric Oncology
  • Source

    Preview · Article ·
Show more