SAN DIEGO — Patients with newly diagnosed acute myeloid leukemia treated with intensive therapy demonstrated higher 2-year overall survival rates than patients treated with non-intensive therapies, according to study results presented at the ASH Annual Meeting and Exposition.
However, mortality rates remained similar in older patients regardless of receiving intensive or non-intensive therapies, according to the study results.
Mohamed L. Sorror
“We found no survival benefit in patients receiving intermediate versus higher dose form of induction therapy and when we combine them together as intensive therapy, the fairest statement that we can say is there is no increase in mortality compared with [non-intensive therapy], even in patients 70 years [or older],” Mohamed L. Sorror, MD, MSc, of the Fred Hutchinson Cancer Research Center, said during a presentation.
Sorror noted that non-intensive therapies are commonly used in patients aged 65 years or older because of concerns associated with the subgroup’s ability to tolerate intensive chemotherapy.
Sorror highlighted that the benefits and risks associated with intensive vs. non-intensive therapies in patients with AML are likely affected by age, presence of comorbidities and disease-related characteristics.
The researchers conducted a retrospective study of 1,295 patients with newly diagnosed AML who were given induction therapy between 2008 and 2012 at six participating academic centers to analyze the relationship between intensive and non-intensive therapies and age and the presence of comorbidities.
The researchers used two validated models to define distinct prognostic groups and then compared 2-year OS according to whether patients received intensive or non-intensive therapies.
Non-intensive therapies included azacitidine (Vidaza, Celgene), decitabine or low-dose cytarabine, while the intensive therapies consisted of the standard “7+3” chemotherapy regimen or high-dose cytarabine combinations with anthracyclines or purine analogs.
The first model the researchers used was a composite of the prognostic effects of age, comorbidity index and cytogenetic risks per the European Leukemia Net (ELN) classification. The other model was a treatment-related mortality (TRM) index.
Twenty-three percent of patients were aged 49 years or younger; 20% were aged 50 to 59 years; 33% were aged 60 to 69 years and 24% were aged 70 years or older.
Using the ELN classification, cytogenetic-molecular risks were favorable (18%), intermediate I and II (39%) or unfavorable (43%). Induction treatments were intensive in 77% of patients. The frequency of intensive therapies decreased as patients’ ages increased. Approximately all patients (99%) aged 49 years or younger received intensive therapy. However, only 20% of patients aged 80 to 92 years (n = 66) received intensive therapy.
Per the composite model grouping, patients with a composite score of 4-6 (n = 389; HR = 0.63; 95% CI, 0.44-0.91) and 7-9 (n = 321; HR = 0.46; 95% CI, 0.35-0.62) achieved higher 2-year OS if they had received intensive therapy.
Patients assessed with TRM index achieved significantly higher 2-year OS rates with intensive therapies if they had a score of 0-4 (n = 342; HR = 0.47; 95% CI, 0.33-0.64) or 5 and higher (n = 367; HR = 0.66; 95% CI, 0.52-0.84).
Forty-one percent of patients aged 70 to 79 years (n = 242) received intensive therapy. Those treated with intensive therapy had higher 2-year OS (HR = 0.73; 95% CI, 0.54-0.98) rates compared with those who received non-intensive therapies.
Sorror noted that intensive therapy could be a valid option for most patients – even up to the age of 80 years – regardless of their comorbidity burden. – by Ryan McDonald
Sorror ML, et al. Abstract 216. Presented at: ASH Annual Meeting and Exposition; Dec. 3-6, 2016; San Diego.
Disclosure: Sorror reports no relevant financial disclosures. Please see the full study for a list of all other relevant financial disclosures.