Elderly patients with acute myeloid leukemia (AML) may benefit enough from induction chemotherapy to undergo curative post-remission therapy such as allogeneic stem cell transplant, according to a study published in the American Journal of Hematology.

In the study, 101 patients (median age, 65 years) underwent a 5 + 1 chemotherapy regimen consisting of 3 g/m2 high dose cytarabine given once daily for 5 continuous days as well as 80 mg/m2 high dose mitoxantrone given on the second day. Patients were stratified by age and risk for analysis.

The overall response rate was 76.2% for all patients. No statistically significant difference in rate of complete response (CR) was observed across the age groups. Patients with secondary AML demonstrated a lower CR rate than patients with de novo AML (63.6% vs 83.5%, P =.04).

The rate of overall survival (OS) at 2 years and 5 years after treatment was 45% and 37%, respectively. Median OS time was 25 months; median OS time for patients younger than 60 years, between 60 and 69 years, and 70 years or older was 56, 31, and 9 months (P =.02), respectively. Median event-free survival (EFS) time across all groups was 8 months.

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The 1-year mortality was 85%, 60%, and 41% for patients younger than 60 years, patients between 60 and 69 years, and patients 70 years or older, respectively. 

The induction therapy was well tolerated. A total of 86 patients received further treatment, including chemotherapy and stem cell transplant, after induction chemotherapy, including 45 of 84 patients in the intermediate and adverse risk groups. There were 2 reports of neurotoxicity in the cohort.

The researchers concluded that the current cutoff used in clinical trials to define elderly populations is arbitrary and that patients with newly diagnosed AML should not be disqualified from receiving induction therapy solely due to their age. They suggested that “the optimal regimen for older patients with AML remains unknown, but further exploration of high dose mitoxantrone-based induction is warranted.”

Reference

1. Saini N, Cerny J, Furtado V, et al. Elderly do benefit from induction chemotherapy: High dose mitoxantrone based (“5+1”) induction chemotherapy regimen in newly diagnosed acute myeloid leukemia [published online November 12, 2018]. Am J Hematol. doi: 10.1002/ajh.25347