Standard intensive chemotherapy is less effective and far more toxic than attenuated induction and post-induction regimen in elderly patients with acute myeloid leukemia

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• 作者：Bin-Tao Huang (1)
  Wei-Hong Zhao (2)
  Qing-Chun Zeng (3)
  Bing-Sheng Li (4)
  Rui-lin Chen (5)
  
• 关键词：Elderly patients ; Acute myeloid leukemia ; Attenuated chemotherapy
• 刊名：Medical Oncology
• 出版年：2014
• 出版时间：May 2014
• 年：2014
• 卷：31
• 期：5
• 全文大小：649 KB
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• 作者单位：Bin-Tao Huang (1)
  Wei-Hong Zhao (2)
  Qing-Chun Zeng (3)
  Bing-Sheng Li (4)
  Rui-lin Chen (5)
  
  1. Department of Hematology, The Affiliated Hospital of Inner Mongolia Medical University, 1 TongDao Avenue North, Hohhot, 010059, People’s Republic of China
  2. Department of Gastroenterology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, 010059, People’s Republic of China
  3. Department of Medicine, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Ave, Guangzhou, Guangdong, 510515, People’s Republic of China
  4. Huizhou Medicine Institute, Huizhou, 516003, People’s Republic of China
  5. Department of Rheumatology and Immunology, Guangzhou Medical College, The Second Affiliated Hospital, Guangzhou, 510260, People’s Republic of China
  
• ISSN：1559-131X

文摘

The open-label, prospective study aimed to evaluate the efficacy and safety for standard intensive chemotherapy compared with attenuated therapy in elderly patients with acute myeloid leukemia (AML). A total of 297 patients between 65 and 82?years were enrolled in the study. The 141 patients received standard-dose therapy (daunorubicin 45?mg/m2?×?3?days with cytarabine 100?mg/m2?×?7?days for induction therapy, while post-induction therapy consisted of high-dose cytarabine 1.5?g/m2?×?4?days), and the attenuated treatment (daunorubicin 30?mg/m2?×?3?days with cytarabine 75?mg/m2?×?7?days for induction therapy, while post-induction therapy consisted of attenuated high-dose Ara-C 1.0?g/m2?×?3?days) was administered to the remaining 156 patients, based on a random number assigned. Total 168 patients (56.6?%) achieved complete remission with an incomplete blood recovery (CR)/CRi. No significant differences were observed between the two treatments (P?=?0.60). Attenuated chemotherapy improved overall survival (OS) and progression-free survival (PFS) compared to standard-dose therapy; 5-year OS values for these two groups were 39 and 24?months, respectively (P?<?0.001), and the PFS values for these two groups were 35 versus 23?months (P?<?0.001). In addition, the attenuated treatment with a poor risk profile overcame the negative impact and yielded OS and PFS values similar to those of the standard-dose chemotherapy with a better-to-intermediate risk profile. Five-year OS values for these two groups were 28 versus 28?months (P?=?0.89), and the 5-year PFS values were 27 and 28?months, respectively (P?=?0.89). The most common adverse drug effect for chemotherapy was agranulocytosis (98.3?%). There was a significant difference in early mortality between the attenuated and standard-dose treatment groups (0.64?% vs. 7.1?%, respectively, P?<?0.01). Standard intensive chemotherapy is less effective and far more toxic than attenuated induction and post-induction regimen in elderly patients with AML.