Despite of advances in the treatment for acute myelogenous leukemia (AML), the response of chemotherapy for the elderly is still poor and there is no definite guideline for the elderly AML patients.
The retrospective analysis with medical chart review was taken to the 82 patients over 65 years old and treated with AML from January 2003 to April 2012 at the Korea University Medical Center. The efficacy of chemotherapy for the elderly patients was evaluated and subgroup analysis was taken to determine which conditions are more effective to the chemotherapy.
Median overall survival period of 82 patients were 3.9 months. 52 patients were treated with chemotherapy (33 patients were standard dose idarubicin plus cytarabine, 19 patients were low dose cytarabine) and 30 patients received best supportive care only. Among the standard chemotherapy group, there were 16 cases of remission (48.5%) after induction chemotherapy. The treatment related mortality was 24.2% and the most common cause was pneumonia sepsis. Median overall survival period of standard chemotherapy group was 7.9 months. In a multivariate analysis, significant factors for longer overall survival were performance status, no underlying heart disease, no fever at diagnosis, high platelet count, low blast count and standard induction chemotherapy. In the subgroup analysis, the efficacy of chemotherapy was observed in the relatively younger patients group (HR 0.437, P =.022), De novo AML group (HR 0.421, P =.025), no underlying heart disease group (HR 0.421, P =.031), high WBC count group (HR 0.306, P =.026), Low platelet count group (HR 0.12, P <.001), high blast counts group (HR 0.233, P =.005), high LDH group (HR 0.21, P=.001).
The result of chemotherapy in the elderly AML patients is poor. However the results of the chemotherapy will be better if the patients are selected appropriately through subgroup analysis.
Choi:the korean society of hematology: Membership on an entity's Board of Directors or advisory committees.
Asterisk with author names denotes non-ASH members.