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Post-remission therapy of adults aged 60 and older with acute myeloid leukemia in first complete remission: role of treatment intensity on the outcome.
Annals of Hematology ( IF 3.5 ) Pub Date : 2020-02-22 , DOI: 10.1007/s00277-020-03922-w
B Bouchacourt 1 , M A Hospital 1 , C Zemmour 2 , J Rey 1 , E d'Incan 1 , A Charbonnier 1 , B Mohty 1 , C Saillard 1 , S Bonnet 1 , A Collignon 1 , V Gelsi-Boyer 3 , M J Mozziconacci 3 , D Blaise 4 , N Vey 4
Affiliation  

Although complete remission (CR) is achieved in 50 to 70% of older fit patients with acute myeloid leukemia (AML), consolidation therapy in this age group remains challenging. In this retrospective study, we aimed to compare outcome in elderly patients treated with different post-remission modalities, including allogenic and autologous hematopoietic stem cell transplantation (HSCT), intensive chemotherapy, and standard-dose chemotherapy (repeated 1 + 5 regimen). We collected data of 441 patients ≥ 60 years in first CR from a single institution. Median age was 67 years. Sixty-one (14%) patients received allo-HSCT, 51 (12%) auto-HSCT, 70 (16%) intensive chemotherapy with intermediate- or high-dose cytarabine (I/HDAC), and 190 (43%) 1 + 5 regimen. Median follow-up was 6.5 years. In multivariate analysis, allo-HSCT, cytogenetics, and PS had a significant impact on OS and LFS. In spite of a more favorable-risk profile, the patients who received I/HDAC had no significantly better LFS as compared with patients treated with 1 + 5 (median LFS 8.8 months vs 10.6 months, p = 0.96). In transplanted patients, median LFS was 13.3 months for auto-HSCT and 25.8 months for allo-HSCT. Pre-transplant chemotherapy with I/HDAC had no effect on the outcome. Toxicity was significantly increased for both transplanted and non-transplanted patients treated with I/HDAC, with more units of blood and platelet transfusion and more time spent in hospitalization, but no higher non-relapse mortality. This study shows that post-remission chemotherapy intensification is not associated with significantly better outcome as compared with standard-dose chemotherapy in elderly patients for whom, overall results remain disappointing.

中文翻译:

首次完全缓解的60岁及以上的急性髓细胞白血病成人的缓解后治疗:治疗强度对预后的作用。

尽管50%至70%的年龄较大的急性髓性白血病(AML)患者达到了完全缓解(CR),但是在这一年龄段的巩固治疗仍然具有挑战性。在这项回顾性研究中,我们旨在比较接受不同缓解后方式(包括同种异体和自体造血干细胞移植(HSCT),强化化疗和标准剂量化疗(重复1 + 5方案))的老年患者的结局。我们从一家机构收集了441例≥60年首次CR的患者的数据。中位年龄为67岁。六十一(14%)名患者接受了all-HSCT,51名(12%)自体HSCT,70名(16%)进行中度或大剂量阿糖胞苷(I / HDAC)的强化化疗,以及190名(43%)1 + 5疗程。中位随访时间为6。5年。在多变量分析中,同种异体造血干细胞移植,细胞遗传学,PS对OS和LFS产生了重大影响。尽管风险更为有利,但接受I / HDAC的患者的LFS与接受1 + 5治疗的患者相比没有明显改善(中位LFS 8.8个月对10.6个月,p = 0.96)。在移植患者中,auto-HSCT的中位LFS为13.3个月,allo-HSCT的中位LFS为25.8个月。I / HDAC的移植前化疗对结局没有影响。接受I / HDAC治疗的移植和未移植患者的毒性均显着增加,血液和血小板输注更多单位,住院时间更长,但非复发死亡率没有更高。这项研究表明,对于老年患者,与标准剂量化疗相比,缓解后化疗的增强与预后明显不相关。
更新日期:2020-02-23
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