Abstract
Real-world evidence is lacking regarding the effectiveness of intensive and non-intensive induction strategies in elderly patients with favorable-risk acute myeloid leukemia (AML).
To estimate the rates of complete remission (CR), CR+ CR with incomplete count recovery (CRi), and overall survival (OS) in patients receiving intensive chemotherapy (IC) and hypomethylating agent (HMA)-based induction regimens.
In this retrospective study, clinical and genomic data were collected by review of records of eligible patients treated at Moffitt Cancer Center. Statistical analyses were performed using SPSS.
Elderly (age > 70 years) patients with newly diagnosed, favorable-risk (ELN 2017) AML.
CR, CR+ CRi, OS.
Out of total 53 patients, 36 (68%) received IC, and 17 (32%) received HMA-based induction regimen. Median age at diagnosis was 74 years (range 70–85). Core binding factor (CBF) abnormalities were detected in 47% patients; 28% had secondary AML. Median blast count was significantly higher in patients receiving IC vs HMA (58% vs 32%, p=0.01). Predominant induction regimen was “7+3” (86%) in the IC group and azacytidine alone (n=11) in HMA cohort. Rate of composite CR (CR+ CRi) was significantly better at 69% (50% CR) in the IC group, compared to 35% (24% CR) with HMA (p=0.01). Six patients on IC and 1 on HMA had early (<30 d) induction-related mortality. Both groups had comparable relapse rates (overall 34%). Median OS was 24.7 months in IC vs 17.5 months in the HMA group, trending toward statistical significance (p=0.058). Overall, 23% patients in the IC group were alive at 5 years, compared to 7% with HMA. In patients with CBF-AML (n=25), median OS was not reached for IC vs 23 months with HMA (p= 0.076); CBF-AML was an independent predictor of survival in the study population. Six patients (3 post-relapse) from the IC group underwent allogeneic stem cell transplant.
Elderly favorable-risk AML patients had a significantly better composite CR rate on induction treatment with IC than with HMA, with a trend toward improved OS with IC-based induction. A multicenter study with a larger sample size is ongoing to address this question further.