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Posted by on Aug 6, 2017 in Leukemia | 0 comments

In a nutshell

This study reviewed treatment strategies for older patients with acute myeloid leukemia (AML).

Some background

AML is a cancer of the blood and bone marrow that mainly affects the elderly. The average age at diagnosis is 67 years. While advances in AML treatment have increased survival, outcomes for the elderly remain poor. A major challenge in managing AML in patients over the age of 60 is balancing the potential benefits of intensive treatment with associated side effects. Age, disease status, and the presence of additional medical conditions typically affect this decision. Treatment strategies that maximize benefit in this age group are needed.

Methods & findings

The aim of this study was to review findings on treatment strategies for older AML patients.

Hypomethylating agents are an important treatment option for older patients. Examples of this type of treatment are azacytidine (Vidaza) and decitabine (Dacogen). They are associated with fewer side effects and are therefore easier to tolerate. Studies have shown significantly improved overall survival (time from treatment until death from any cause) with these agents compared to conventional care. One study examined 84 elderly patients treated with monthly cycles of decitabine. Intermediate- or high-risk AML patients had higher response rates (67%) compared to low-risk AML (34%). Patients with a genetic mutation on the TP53 gene had a response rate of 100%.

Consolidation therapy is treatment to maintain remission. Chemotherapy has generally not been effective as consolidation therapy in elderly AML patients. A study of 330 older AML patients examined the benefits of using a hormone therapy, norethandrolone (Nilevar), after complete remission (CR) was achieved. Patients in CR have no sign of active disease. 31.2% of patients treated with norethandrolone were leukemia-free at 5 years. This was significantly greater compared to those not treated (16.2%).

Stem cell transplantation after reduced-intensity conditioning (RIC) is an important consolidation strategy for elderly patients. Only about 6% of elderly AML patients, however, eventually go on to stem cell transplantation. One study analyzed the records of 600 patients undergoing a stem cell transplant. The study concluded that age did not affect overall survival. An analysis of 24 studies concluded that stem cell transplantation can be recommended for elderly patients with high-risk AML who are in their first CR. Of those in second remission, only low- and intermediate-risk patients benefit.

There are multiple factors that are used to divide older patients into risk groups. These include age, other medical conditions, symptom burden, and frailty. One study reported significant differences in overall survival between different risk groups. The low-risk group had an overall survival of 744 days, followed by intermediate (231 days) and high-risk (51 days).

CPX-351 (VYXEOS) is a recently developed drug for managing AML in older patients. It is a combination of the chemotherapy drugs cytarabine (Cytosar-U) and daunorubicin (Cerubidine). Overall survival and response rates were significantly improved compared to standard induction therapy for patients between 60 to 75 years old. Other new agents still under investigation include vosaroxin (QINPREZO), guadecitabine (SGI-110), sapacitabine (CYC682), enasidenib (AG-221), and quizartinib (AC220).

The bottom line

Authors summarized a number of treatment options based on the results of clinical trials involving elderly AML patients.

Published By :

Current hematologic malignancy reports

Date :

May 31, 2017

Original Title :

Patterns of Care and Survival for Elderly Acute Myeloid Leukemia-Challenges and Opportunities.

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