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Treatment with Low-Dose Cytarabine in Elderly Patients (Age 70 Years or Older) with Acute Myeloid Leukemia: A Single Institution Experience.

Heiblig M, Elhamri M, Tigaud I, Plesa A, Barraco F, Labussière H, Ducastelle S, Michallet M, Nicolini F, Plesa C, Wattel E, Salles G, Thomas X - Mediterr J Hematol Infect Dis (2016)

Bottom Line: Survival with LD-AraC was better than with BSC only (P = 0.001).There was no clear evidence that a beneficial effect of LD-AraC was restricted to any particular subtype of patients, except for cytogenetics.All this tends to confirm that LD-AraC can still represent a baseline against which new promising agents may be compared either alone or in combination.

View Article: PubMed Central - PubMed

Affiliation: Department of Hematology, Lyon-Sud Hospital, Hospices Civils de Lyon, Pierre Bénite, France.

ABSTRACT

Objectives: Low-dose cytarabine (LD-AraC) is still regarded as the standard of care in elderly patients with acute myeloid leukemia (AML) 'unfit' for intensive chemotherapy. In this study, we reported our experience with LD-AraC in patients ≥ 70 years old and compared the results to those of intensive chemotherapy, best supportive care (BSC), or hypomethylating agents in the same age population.

Methods: Between 2000 and 2014, 60 patients received LD-AraC at 20 mg once or twice daily by subcutaneous injection for 10 consecutive days every 4-6 weeks.

Results: Complete remission rate with LD-AraC was 7% versus 56% with intensive chemotherapy and 21% with hypomethylating agents. Median overall survival (OS) of patients treated with LD-AraC was 9.6 months with 3-year OS of 12%. Survival with LD-AraC was better than with BSC only (P = 0.001). Although not statistically significant, intensive chemotherapy and hypomethylating agents tended to be better than LD-AraC in terms of OS (median: 12.4 months and 16.1 months, respectively). There was no clear evidence that a beneficial effect of LD-AraC was restricted to any particular subtype of patients, except for cytogenetics. There was a trend for a better OS in LD-AraC treated patients in the setting of clinical trials as compared with those treated outside of a clinical trial.

Conclusions: Despite a trend in favor of intensive chemotherapy and hypomethylating agents over LD-AraC, no real significant advantage could be demonstrated, while LD-AraC showed a significant advantage comparatively to BSC. All this tends to confirm that LD-AraC can still represent a baseline against which new promising agents may be compared either alone or in combination.

No MeSH data available.


Related in: MedlinePlus

Overall survival: LD-AraC versus intensive chemotherapy.
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f2-mjhid-8-1-e2016009: Overall survival: LD-AraC versus intensive chemotherapy.

Mentions: Survival with LD-AraC was better than that with BSC only (median OS: 9.6 months vs. 3.4 months; P = 0.001) (Figure 1). Although not statistically significant, intensive chemotherapy tended to be better than LD-AraC in terms of OS (median OS: 12.4 months vs. 9.6 months; 3-year OS: 27% vs. 12%; P = 0.07) (Figure 2). However, differences in favor of intensive chemotherapy were only confirmed for patients aged less than 75 years (median: 12.7 months vs. 9.2 months; 3-year OS: 28% vs. 10%). In patients aged ≥ 75 years, median OS was better with LD-AraC (9.6 months vs. 2.8 months). Although there was a trend for better results with hypomethylating agents, no significant differences were observed when compared with LD-AraC (median OS: 16.1 months with hypomethylating agents vs. 9.6 months with LD-AraC; 3-year OS: 22% vs. 12%; P = 0.1) (Figure 3). In a multivariate analysis including cytogenetics (unfavorable vs. intermediate/favorable risk), age (< 75 years vs. ≥ 75 years), de novo or secondary AML, and the type of treatment, only cytogenetics was of prognostic value (HR, 1.93; 95% CI, 1.50–2.47; P < 0.001).


Treatment with Low-Dose Cytarabine in Elderly Patients (Age 70 Years or Older) with Acute Myeloid Leukemia: A Single Institution Experience.

Heiblig M, Elhamri M, Tigaud I, Plesa A, Barraco F, Labussière H, Ducastelle S, Michallet M, Nicolini F, Plesa C, Wattel E, Salles G, Thomas X - Mediterr J Hematol Infect Dis (2016)

Overall survival: LD-AraC versus intensive chemotherapy.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4696467&req=5

f2-mjhid-8-1-e2016009: Overall survival: LD-AraC versus intensive chemotherapy.
Mentions: Survival with LD-AraC was better than that with BSC only (median OS: 9.6 months vs. 3.4 months; P = 0.001) (Figure 1). Although not statistically significant, intensive chemotherapy tended to be better than LD-AraC in terms of OS (median OS: 12.4 months vs. 9.6 months; 3-year OS: 27% vs. 12%; P = 0.07) (Figure 2). However, differences in favor of intensive chemotherapy were only confirmed for patients aged less than 75 years (median: 12.7 months vs. 9.2 months; 3-year OS: 28% vs. 10%). In patients aged ≥ 75 years, median OS was better with LD-AraC (9.6 months vs. 2.8 months). Although there was a trend for better results with hypomethylating agents, no significant differences were observed when compared with LD-AraC (median OS: 16.1 months with hypomethylating agents vs. 9.6 months with LD-AraC; 3-year OS: 22% vs. 12%; P = 0.1) (Figure 3). In a multivariate analysis including cytogenetics (unfavorable vs. intermediate/favorable risk), age (< 75 years vs. ≥ 75 years), de novo or secondary AML, and the type of treatment, only cytogenetics was of prognostic value (HR, 1.93; 95% CI, 1.50–2.47; P < 0.001).

Bottom Line: Survival with LD-AraC was better than with BSC only (P = 0.001).There was no clear evidence that a beneficial effect of LD-AraC was restricted to any particular subtype of patients, except for cytogenetics.All this tends to confirm that LD-AraC can still represent a baseline against which new promising agents may be compared either alone or in combination.

View Article: PubMed Central - PubMed

Affiliation: Department of Hematology, Lyon-Sud Hospital, Hospices Civils de Lyon, Pierre Bénite, France.

ABSTRACT

Objectives: Low-dose cytarabine (LD-AraC) is still regarded as the standard of care in elderly patients with acute myeloid leukemia (AML) 'unfit' for intensive chemotherapy. In this study, we reported our experience with LD-AraC in patients ≥ 70 years old and compared the results to those of intensive chemotherapy, best supportive care (BSC), or hypomethylating agents in the same age population.

Methods: Between 2000 and 2014, 60 patients received LD-AraC at 20 mg once or twice daily by subcutaneous injection for 10 consecutive days every 4-6 weeks.

Results: Complete remission rate with LD-AraC was 7% versus 56% with intensive chemotherapy and 21% with hypomethylating agents. Median overall survival (OS) of patients treated with LD-AraC was 9.6 months with 3-year OS of 12%. Survival with LD-AraC was better than with BSC only (P = 0.001). Although not statistically significant, intensive chemotherapy and hypomethylating agents tended to be better than LD-AraC in terms of OS (median: 12.4 months and 16.1 months, respectively). There was no clear evidence that a beneficial effect of LD-AraC was restricted to any particular subtype of patients, except for cytogenetics. There was a trend for a better OS in LD-AraC treated patients in the setting of clinical trials as compared with those treated outside of a clinical trial.

Conclusions: Despite a trend in favor of intensive chemotherapy and hypomethylating agents over LD-AraC, no real significant advantage could be demonstrated, while LD-AraC showed a significant advantage comparatively to BSC. All this tends to confirm that LD-AraC can still represent a baseline against which new promising agents may be compared either alone or in combination.

No MeSH data available.


Related in: MedlinePlus