Simple Summary Intensive induction strategies are rarely used for older patients in community on-cology practice, with comorbidities being the major cause of contraindication. We conducted a multicentric retrospective study to evaluate activity and safety in a real-life setting of hypomethylating drugs (HMAs) in patients older than 75 years with AML. In multivariate analysis, age (>= 80), Charlson comorbidity index (>= 3), creatinine clearance and the type of best response (>= PR) during treatment maintained independent significance in predicting survival. Furthermore, our data show that HMAs have similar efficacy compared to pivotal trials and are well tolerated in a setting of very elderly patients with several co-comorbidities. Elderly patients represent the most challenging and hard-to-treat patient population due to dismal characteristics of the disease, such as secondary-acute myeloid leukemia (AML), enrichment of unfavorable molecular genes (TP53) and comorbidities. We conducted a multicentric retrospective study to evaluate activity and safety in a real-life setting of hypomethylating drugs (HMAs) in patients older than 75 years with AML. Between September 2010 and December 2021, 220 patients were treated, 164 (74.5\%) received AZAcitidine and 56 DECitabine; most patients (57.8\%), received more than four cycles of HMAs. The best response obtained was CR in 51 patients (23.2\%), PR in 23 (10.5\%) and SD in 45 (20.5\%); overall transfusion independence was obtained in 47 patients (34\%), after a median of 3.5 months. The median OS (mOs) was 8 months (95\% CI 5.9-10.2), with 1- and 2-years OS of 39.4\% (95\% CI 32.7-46) and 17.4\% (95\% CI 11.7-23.1), respectively; similar mOS was observed according to HMA treatment (AZA 8.3 vs. DEC 7.8 months, p = 0.810). A subset of 57 long survivors (44 in AZA group and 13 in DEC group) received at least 12 cycles of HMAs, their mOS was 24.3 months. In multivariate analysis, age (>= 80), Charlson comorbidity index (>= 3), creatinine clearance and the type of best response (>= PR) during treatment maintained independent significance in predicting survival. Infectious complications, most frequently pneumonia (35) and septic shock (12), were lethal in 49 patients (22.2\%). Our data show that HMAs have similar efficacy compared to pivotal trials and are well tolerated in a setting of very elderly patients with several co-comorbidities.
Identification of Predictive Factors for Overall Survival and Response during Hypomethylating Treatment in Very Elderly (≥75 Years) Acute Myeloid Leukemia Patients: A Multicenter Real-Life Experience / Molica, Matteo; Mazzone, Carla; Niscola, Pasquale; Carmosino, Ida; Di Veroli, Ambra; De Gregoris, Cinzia; Bonanni, Fabrizio; Perrone, Salvatore; Cenfra, Natalia; Fianchi, Luana; Piccioni, Anna Lina; Spadea, Antonio; Luzi, Giovanni; Mengarelli, Andrea; Cudillo, Laura; Maurillo, Luca; Pagano, Livio; Breccia, Massimo; Rigacci, Luigi; De Fabritiis, Paolo. - In: CANCERS. - ISSN 2072-6694. - 14:19(2022). [10.3390/cancers14194897]
Identification of Predictive Factors for Overall Survival and Response during Hypomethylating Treatment in Very Elderly (≥75 Years) Acute Myeloid Leukemia Patients: A Multicenter Real-Life Experience
Carmosino, Ida;Breccia, Massimo;
2022
Abstract
Simple Summary Intensive induction strategies are rarely used for older patients in community on-cology practice, with comorbidities being the major cause of contraindication. We conducted a multicentric retrospective study to evaluate activity and safety in a real-life setting of hypomethylating drugs (HMAs) in patients older than 75 years with AML. In multivariate analysis, age (>= 80), Charlson comorbidity index (>= 3), creatinine clearance and the type of best response (>= PR) during treatment maintained independent significance in predicting survival. Furthermore, our data show that HMAs have similar efficacy compared to pivotal trials and are well tolerated in a setting of very elderly patients with several co-comorbidities. Elderly patients represent the most challenging and hard-to-treat patient population due to dismal characteristics of the disease, such as secondary-acute myeloid leukemia (AML), enrichment of unfavorable molecular genes (TP53) and comorbidities. We conducted a multicentric retrospective study to evaluate activity and safety in a real-life setting of hypomethylating drugs (HMAs) in patients older than 75 years with AML. Between September 2010 and December 2021, 220 patients were treated, 164 (74.5\%) received AZAcitidine and 56 DECitabine; most patients (57.8\%), received more than four cycles of HMAs. The best response obtained was CR in 51 patients (23.2\%), PR in 23 (10.5\%) and SD in 45 (20.5\%); overall transfusion independence was obtained in 47 patients (34\%), after a median of 3.5 months. The median OS (mOs) was 8 months (95\% CI 5.9-10.2), with 1- and 2-years OS of 39.4\% (95\% CI 32.7-46) and 17.4\% (95\% CI 11.7-23.1), respectively; similar mOS was observed according to HMA treatment (AZA 8.3 vs. DEC 7.8 months, p = 0.810). A subset of 57 long survivors (44 in AZA group and 13 in DEC group) received at least 12 cycles of HMAs, their mOS was 24.3 months. In multivariate analysis, age (>= 80), Charlson comorbidity index (>= 3), creatinine clearance and the type of best response (>= PR) during treatment maintained independent significance in predicting survival. Infectious complications, most frequently pneumonia (35) and septic shock (12), were lethal in 49 patients (22.2\%). Our data show that HMAs have similar efficacy compared to pivotal trials and are well tolerated in a setting of very elderly patients with several co-comorbidities.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
