The prognosis for nearly three quarters of elderly patients (age 70 and over) with acute myeloid leukemia receiving intensive chemotherapy is unfortunately poor, with a median survival of less than six months, according to a study now available online ahead of print in Blood.
“Recent studies have suggested that intensive chemotherapy might benefit elderly patients with AML, but we found that not to be the case,” said Hagop Kantarjian, MD, Chairman of the Leukemia Department at the University of Texas MD Anderson Cancer Center.
“Patients who did not have any of the eight-week mortality predictors we identified in the study may benefit from the more intense treatment, but for the majority of AML patients of advanced age, lower-intensity treatments are a better, less risky option.”
As a news release notes, since most clinical trials of AML have excluded patients older than 55, physicians have had to infer that treatments that work for younger patients will also work for older patients.
Dr. Kantarjian and his colleagues, though, focused on older patients with AML in order to provide more conclusive information about treatment in this population. Included were 446 AML patients age 70 or older who were given a cytarabine-based intensive chemotherapy regimen between 1990 and 2008.
Although 45% of the patients had a complete remission, 154 patients (some who were in remission as well as some who were not) died during the first eight weeks after treatment began. Causes of death included both treatment toxicity and ineffective therapy leading to disease progression.
The researchers analyzed the patients to identify those most at risk for this eight-week mortality rate and found the following predictive factors:
- Age greater than 80.
- 3 or more genetic abnormalities.
- Poor performance as indicated by an ECOG score of 2-4.
- Creatinine levels greater than 1.3 mg.
The more of these factors patients had, the poorer their survival outcome with intensive chemotherapy.
Among those who did not have any of these risk factors (28%), only 16% died within eight weeks, vs 71% for patients with three or more adverse factors (9%).
“When doctors and patients are discussing intensive chemotherapy as a treatment option for AML, they must take these mortality risk factors into consideration to determine whether the patient is likely to benefit from this type of treatment,” said Dr. Kantarjian.