Feasibility and results of autologous stem cell transplantation in de novo acute myeloid leukemia in patients over 60 years old. Results of the CETLAM AML-99 protocol

• Published in: Haematologica (Roma) Vol. 89; no. 7; pp. 791 - 800
• Main Authors: Oriol, A, Ribera, JM, Esteve, J, Guardia, R, Brunet, S, Bueno, J, Pedro, C, Llorente, A, Tormo, M, Besalduch, J, Sanchez, JM, Batlle, M, Vivancos, P, Carreras, E, Vila, JM, Julia, A, Sierra, J, Montserrat, E, Feliu, E, CETLAM AML-99
• Format: Journal Article
• Language: English
• Published: Pavia Haematologica 01-07-2004
• Subjects: Acute Disease; Age Factors; Aged; Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biological and medical sciences; Combined Modality Therapy; Cytarabine - administration & dosage; Disease-Free Survival; Etoposide - administration & dosage; Female; Hematologic and hematopoietic diseases; Hematopoietic Stem Cell Transplantation; Humans; Idarubicin - administration & dosage; Leukemia, Myeloid - drug therapy; Leukemia, Myeloid - therapy; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Logistic Models; Male; Medical sciences; Middle Aged; Mitoxantrone - administration & dosage; Proportional Hazards Models; Remission Induction; Transplantation, Autologous; Human; elderly patients; Hematology; Acute; Stem cell; autologous stem cell transplantation; Hematopoietic cell; Malignant hemopathy; Survival; De novo; Autograft; acute myeloid leukemia; Graft; Feasibility; Elderly; Acute myelocytic leukemia
• ISSN: 0390-6078; 1592-8721

CETLAM Group, Catalonia, Spain. [e-mail]
BACKGROUND AND OBJECTIVES: The benefits of high-dose cytarabine, anthracyclines and hematopoietic stem cell transplantation in the treatment of acute myeloid leukemia (AML) are greater in younger rather than in older patients. We assessed the proportion of patients over 60 years with de novo AML who qualified for intensive therapy and determined the feasibility and results of autologous stem cell transplantation (ASCT) in first complete remission (CR). DESIGN AND METHODS: Induction therapy included idarubicin, cytarabine and etoposide. Patients who achieved CR received one cycle of mitoxantrone and cytarabine and ASCT as consolidation therapies. RESULTS: Over a 4-year period, 258 patients were registered of whom 135 (52%) were enrolled for intensive treatment. The CR rate was 61%, advanced age (p=0.033) and unfavorable cytogenetics (p=0.015) emerged as independent negative prognostic factors for CR. The 2-year overall survival (OS) was 23 % (CI 14%-30%) and was poorer in patients with unfavorable cytogenetics (p=0.035), age over 70 years (p=0.019) or leukocytosis (p=0.006). Only 27% of the potential candidates underwent ASCT. The probability of 2-year leukemia-free survival after consolidation was 39% (CI 6%-71%) for these patients and 22% (CI 6% - 39%) for candidate patients not undergoing ASCT (p=0.07). INTERPRETATION AND CONCLUSIONS: Over 25% of the patients 60 to 70 years with de novo AML benefit from standard intensive treatment. In these patients, ASCT has a tolerable toxicity and may have a positive impact on leukemia-free survival.