Skip to main content
Log in

Induction chemotherapy versus palliative treatment for acute myeloid leukemia in a consecutive cohort of elderly patients

  • Original Article
  • Published:
Annals of Hematology Aims and scope Submit manuscript

Abstract

A retrospective survey of 210 consecutive patients aged ≥65 years (median age 69 years, range 65–88 years) with acute myeloid leukemia (AML) diagnosed at a single center over a 6-year period (January 2001 to December 2006) is presented. De novo AML was diagnosed in 179 (85.2 %) patients and 31 (14.7 %) patients had a secondary AML. Twenty-three patients had M0 (11 %), 36 M1 (17.15 %), 57 M2 (27.1 %), eight M3 (3.8 %), 45 M4 (21.4 %), 31 M5 (14.8 %), one M6 (0.5 %), one M7 (0.5 %), and eight patients had unclassified myeloid leukemia (3.8 %) according to French-American-British (FAB) Study Group Classification. Eight patients with M3 (acute promyelocytic leukemia) were excluded from the study. Cytogenetic analysis was performed in 172/202 (85 %) patients. The normal karyotype was found in 81/172 (47 %), high risk aberrations in 32/172 (18.6 %), and favorable karyotype in 13/172 (7.5 %) patients. Supportive and palliative therapies were applied in 115 (56.9 %) patients, a no induction chemotherapy (NIC) group, and 87 (43.1 %) patients received induction chemotherapy (IC group). Complete remission (CR) was achieved in 45/87 (51.7 %) in the IC group and in 5/115 (4.3 %) in the NIC group of patients. After a median follow up of 4 years, 194 (96 %) patients died. The variables significantly associated with a longer overall survival (OS) by univariate analysis were an age of <75 years, a better ECOG performance status (PS) (p = 0.000, CI 95.0 %, 1.358–2.049), a serum LDH activity <600 U/l (p = 0.000, CI 95.0 %, 1.465–2.946), lower white blood cell (WBC) count at diagnosis (p = 0.011, CI 95.0 %, 1.102–2.100), lower comorbidity HCT-CI index (p = 0.000, CI 95 % 2.209–3.458), absence of splenomegaly (p = 0.015, CI 95.0 %, 1.082–2.102) and hepatomegaly (p = 0.008, CI 95.0 %, 1.125–2.171), and no preceding nonhematological malignancy. Multivariate analysis showed that significant factors affecting OS in the IC group were achievement of CR (p = 0.000), the ECOG PS (p = 0.045) and the ECOG PS (p = 0.000), and HCT-CI (p = 0.000) in the NIC group of elderly patients. The present study suggests that a subgroup of elderly patients with both ECOG PS and HCT-CI ≤ 2 at presentation may be eligible for intensive induction chemotherapy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Baz R, Rodriguez C, Fu ZA, Jawde RA, Kalaycio M, Advani A, Sobecks R, Sekers MA (2007) Impact of remission induction chemotherapy on survival in older adults with acute myeloid leukemia. Cancer 110:1752–1759

    Article  PubMed  CAS  Google Scholar 

  2. Baudard M, Marie JP, Cadiou M, Viguie F, Zittoun R (1994) Acute myelogenous leukemia in the lederly: retrospective study of 235 patients. Br J Haematol 86:82–91

    Article  PubMed  CAS  Google Scholar 

  3. Taylor PR, Reid MM, Stark AN, Bown N, Hamilton PJ, Proctor SJ (1995) De novo acute myeloid leukemia in patients over 55 years old: a population-based study of incidence, treatment and outcome. Northern region Hematology Group. Leukemia 9:231–237

    PubMed  Google Scholar 

  4. Hamblin TH (1995) Disappointments in treating acute leukemia in the elderly. N Engl J Med 332:1712–1713

    Article  PubMed  CAS  Google Scholar 

  5. Lowenberg B, Ossenkoppele GJ, Putten WV, Schouten HC (2009) High-dose daunorubicin in older patients with acute myeloid leukemia. N Engl J Med 361:1235–1248

    Article  PubMed  Google Scholar 

  6. Sorror ML, Maris MB, Storb R, Baron F, Sandmaier BM, Maloney DG, Storer B (2005) Hematopoietic cell transplantation (HCT)-specific comorbidity index: a new tool for risk assessment before allogeneic HCT. Blood 106: 2912–2919

    Google Scholar 

  7. Latagliata R, Petti MC, Mandelli F (1999) Acute myeloid leukemia in elderly ‘per aspera ad astra’. Leuk Res 23:1–11

    Article  Google Scholar 

  8. Dalley ChD, Lillington DL, Bradburn M, Carter M, Amess JA, Rohatiner A, Lister A (2002) Acute myelogenous leukemia in older patients at St Bartholomew’s. Hematol J 3:237–243

    Article  PubMed  CAS  Google Scholar 

  9. Sanz MA, Martín G, Rayón C, Esteve J, González M, Díaz-Mediavilla J, Bolufer P, Barragán E, Terol MJ, González JD, Colomer D, Chillón C, Rivas C, Gómez T, Ribera JM, Bornstein R, Román J, Calasanz MJ, Arias J, Alvarez C, Ramos F, Debén G (1999) A modified AIDA protocol with anthracycline-based consolidation results in high antileukemic efficacy and reduced toxicity in newly diagnosed PML/RARalpha-positive acute promyelocytic leukemia. PETHEMA group. Blood 94:3015–3021

    PubMed  CAS  Google Scholar 

  10. Kantarjian H, O’Brien S, Cortes J, Giles F, Faderi S, Jabbour E, Garcia-Manero G, Wierda W, Pierce Sh, Shan J, Estey E (2006) Results of intensive chemotherapy in 998 patients age 65 years or older with acute myeloid leukemia or high-risk myelodysplastic syndrome. Cancer 106:1090–1098

    Article  PubMed  Google Scholar 

  11. Bennett JM, Catovsky D, Daniel MT, Flandrin G, Galton DA, Gralnick HR, Sultan C (1985) Proposed revised criteria for the classification of acute myeloid leukemia. A report of the French-American-British Cooperative Group. Ann Intern Med 103:620–625

    PubMed  CAS  Google Scholar 

  12. Roche G, Schmitz G (1996) Consensus protocol for the flow cytometric immunophenotyping of hematopoietic malignancies. Leukemia 10:877–895

    Google Scholar 

  13. Plesa C, Chelghoum Y, Plesa A, Elhamri M, Tigaud I, Michallet M, Dumontet Ch, Thomas X (2008) Prognostic value of immunophenotyping in elderly patients with acute myeloid leukemia. Cancer 112:572–580

    Article  PubMed  Google Scholar 

  14. Novak A, Kruškić M, Ludoški M, Jurukovski V (1994) Rapid method1 for obtaining high qaulity chromosome banding in the study of hemopoietic neoplasia. Cancer Genet Cytogenet 74:109–114

    Article  PubMed  CAS  Google Scholar 

  15. ISCN: An International System for Human Cytogenetic Nomenclature (2009) LG Shaffer, ML Slovak, LJ Campbell (Eds) S. Karger, Basel

  16. Byrd JC, Mrozek K, Dodge RK et al (2002) Pretreatment cytogenetic abnormalities are predictive of induction success, cumulative incidence of relapse, and overall survival in adult patients with de novo acute myeloid leukemia:results from Cancer and Leukemia Group B (CALGB 8461). Blood 100:4325–4336

    Article  PubMed  CAS  Google Scholar 

  17. Behringer B, Pitako JA, Kunzmann R, Schmoor C, Behringer D, Mertelsmann R, Lubert M (2003) Prognosis of older patients with acute myeloid leukemia receiving either induction or noncurative treatment: a single-center retrospective study. Ann Hematol 82:381–389

    Article  PubMed  CAS  Google Scholar 

  18. Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383

    Article  PubMed  CAS  Google Scholar 

  19. Oken MM, Creech RH, Tormey DC, Horton J, Davis TE, McFadden ET, Carbone PP (1982) Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol 5:649–655

    Article  PubMed  CAS  Google Scholar 

  20. Colovic M, Jankovic G, Petrovic M (1990) Long term survival and late relapses in acute leukemia in adults. Br J Haematol 76:560–561

    Article  PubMed  CAS  Google Scholar 

  21. Brincker H (1985) Estimate of overall results in acute nonlymphocytic leukemia based on age specific rates of incidence and complete remission. Cancer Treat Rep 69:5–11

    PubMed  CAS  Google Scholar 

  22. Pinto A, Zagonel A, Ferrara F (2001) Acute myeloid leukemia in the elderly: biology and therapeutic strategies. Crit Rev Oncol Hematol 39:275–287

    Article  PubMed  CAS  Google Scholar 

  23. Knipp S, Hildebrand B, Kungdgen A, Giagounidis A, Kobbe G, Haas R, Aul C, Gattermann N, Germing U (2007) Intensive chemotherapy is not recommended for patients >60 years who have myelodysplastic syndromes or acute myeloid leukemia with high-risk karyotypes. Cancer 110:345–352

    Article  PubMed  CAS  Google Scholar 

  24. Martin M, Abboud CN (2008) Induction therapy for elderly patients with acute myeloid leukemia. Blood Rev 22:311–320

    Article  PubMed  CAS  Google Scholar 

  25. Rollig Ch, Thiede Ch, Gramatzki M, Aulitzky W et al (2010) A novel prognostic model in elderly patients with acute myeloid leukemia: results of 909 patients entered into the prospective AML96 trial. Blood 116:971–978

    Article  PubMed  Google Scholar 

  26. Latagliata R, Bongarzoni V, Carmosino I, Mengarelli A, Breccia M, Borza PA, D’Andrea M, D’Elia GM, Mecarocci S, Morano SG, Petti MC, Mandelli F, Alimena G (2006) Acute myelogenous leukemia in elderly patients not eligible for intensive chemotherapy: the dark side of the moon. Ann Oncol 17:281–285

    Article  PubMed  CAS  Google Scholar 

  27. Sekeres M, Elson P, Kalaycio ME, Advani AS, Copelan EA, Faderi S, Kantarjian H, Estey E (2009) Time from diagnosis to treatment initiation predicts survival in younger, but not older, acute myeloid leukemia. Blood 113:28–36

    Article  PubMed  CAS  Google Scholar 

  28. Stasi R, Venditti A, Del Poeta G et al (1996) Intensive treatment of patients age 60 years and older with de novo acute myeloid leukemia. Cancer 77:2476–2488

    Article  PubMed  CAS  Google Scholar 

  29. Malfuson JV, Etienne A, Turlure P, de Revel T, Thomas X, Contentin N, Terre Ch, Rigaudeau S, Bordessoule D, Vey N, Gardin C, Dombert H (2008) Risk factors and decision criteria for intensive chemotherapy in older patients with acute myeloid leukemia. Haematologica 93:1806–1813

    Article  PubMed  CAS  Google Scholar 

  30. Menzin J, Lang K, Earle CC, Kkerney D, Mallick R (2002) The outcomes and costs of acute myeloid leukemia among elderly. Arch Intern Med 162:1597–1603

    Article  PubMed  Google Scholar 

  31. Lowenberg B, Yittoun R, Kerkhofs H, Jehn U, Abels J, Debusscher C, Cauchie C, Peetermans M, Solbu G, Suciu S (1989) On the value of intensive remission–induction chemotherapy in elderly patients of 65+ years with acute myeloid leukemia: a randomized phase III study of the European Organization for Research and Treatment Cancer Leukemia Group. J Clin Oncol 7:1268–1274

    PubMed  CAS  Google Scholar 

  32. Resegotti L (1992) Treatment of acute nonlymphoid leukemia (ANLL) in elderly patients. The GIMEMA experience. Leukemia 6(suppl 2):72–75

    PubMed  Google Scholar 

Download references

Acknowledgments

This work is supported by grant number III 41004, Ministry of Education and Science Republic of Serbia.

Conflict of interest

The authors declare no conflict of interest.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Milica Colovic.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Colovic, M., Colovic, N., Radojkovic, M. et al. Induction chemotherapy versus palliative treatment for acute myeloid leukemia in a consecutive cohort of elderly patients. Ann Hematol 91, 1363–1370 (2012). https://doi.org/10.1007/s00277-012-1478-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00277-012-1478-2

Keywords

Navigation