Not type of induction therapy but consolidation with allogeneic hematopoietic cell transplantation determines outcome in older AML patients: A single center experience of 355 consecutive patients

Jacobien Hilberink*, Carin Hazenberg, Eva van den Berg, André Mulder, Jan Jacob Schuringa, Lieke van der Helm, Marco de Groot, Goda Choi, Geertruida H de Bock, Edo Vellenga, Emanuele Ammatuna, Gerwin Huls

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

Therapeutic decision making is often challenging in older AML patients. We collected retrospective data of 355 consecutive AML patients (>= 60 years) who were treated with intensive chemotherapy (IC) (n=155), hypomethylating agents (HMA) (n=83), or best supportive care (BSC) (n=117) between 2002 and 2017. Overall survival (OS) and response rates after therapy were analyzed. Multivariate Cox regression was performed to analyze the impact of different treatment strategies on survival. The median OS was not significantly different between patients treated with IC or HMA (14.9 vs 10.9 months; HR=1.32, p=0.076)), despite a difference in complete remission rate (59% after IC vs 35% after HMA). Patients who received a allogeneic hematopoietic cell transplantation (allo HCT) after treatment with IC or HMA had a significant survival benefit compared to patient who didn't proceed to allo HCT (median OS 65 vs 8 months, respectively, p <0.001). The type of induction therapy (i. e. IC or HMA) did not impact on survival after allo HCT (48 vs 65 months, respectively, p=0.440). In conclusion, consolidation with an allo HCT provides a significant benefit for older AML patients independent of upfront treatment with IC or HMA. Our data suggest that more older patients should be considered for an allo HCT.

Original languageEnglish
Pages (from-to)33-39
Number of pages7
JournalLeukemia Research
Volume80
Early online date2019
DOIs
Publication statusPublished - May-2019

Keywords

  • Acute myeloid leukemia
  • Elderly
  • Hypomethylating agents
  • Intensive chemotherapy
  • Best supportive care
  • Allogeneic hematopoietic cell transplantation
  • ACUTE MYELOID-LEUKEMIA
  • CONVENTIONAL CARE REGIMENS
  • LOW-DOSE CYTARABINE
  • INTENSIVE CHEMOTHERAPY
  • COMORBIDITY INDEX
  • SUPPORTIVE CARE
  • SURVIVAL
  • AZACITIDINE
  • ADULTS
  • AGE

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