Abstract

Background: The use of azatidine (AZT) is the agent of choice for first line treatment of elderly (age >74 years) patients (pts) with high risk MDS or AML (2015 National Comprehensive Cancer Network Guidelines). The Hematology consultant is frequently involved in the care of very elderly (age >79 years) individuals. Our aim is to report our experience with 3 patient aged 80 or above that received treatment with AZT.

Methods: Retrospective review

Results: We reviewed the medical records of patients treated for high risk MDS or AML at our institution between July 2009 and March 2012. A total of 3 pts aged 80 or above were identified. All three pts were males, and all received AZT 100 mg/m2/day x 7 days subcutaneously in every cycle of 28 days. Patient 1 (aged 81) had 12 % of blasts in the bone marrow (BM), was diagnosed with Refractory Anemia with Excess Blasts-2 (RAEB-2) applying the 2008 World Health Organization Classification (WHO) of MDS. Patient 2 (aged 90) had AML with multilineage dysplasia and 38% blasts in BM. Patient 3 (aged 80) had AML with multilineage dysplasia and 30% blasts in BM. Pts characteristics and results are summarized in Table 1.

Conclusions: In pts diagnosed with high risk MDS or AML, advanced chronological age (> 79 years) alone should not preclude the use of effective and well tolerated therapy. Identification of pts in this geriatric subgroup who may benefit from AZT merits additional research.

Table 1.
DiagnosisAge(years)Baseline laboratory Peripheral blood%Blast in Bone MarrowNumber of AZT cycles receivedResponseSurvival(months)
Patient 1 RAEB-2 81 Hb 14 g/dl
Platelets 56x10e9/L
Leucocytes 1.90x10e9/L (Neutrophils 0.81x10e9/L) 
12 11 CR* in BM after 6 cycles 17 
Patient 2 AML 90 Hb 8.06 g/dl
Platelets 20x10e9/L
Leucocytes 1.30x10e9/L(Neutrophils 0.64x10e9/L) 
38 15 CR in BM after 7 cycles 22 
Patient 3 AML 80 Hb 7.50 g/dl
Platelets 30x10e9/L
Leucocytes 6.00x10e9/L(Neutrophils 1.44x10e9/L) 
30 19 CR in BM after 6 cycles 23 
DiagnosisAge(years)Baseline laboratory Peripheral blood%Blast in Bone MarrowNumber of AZT cycles receivedResponseSurvival(months)
Patient 1 RAEB-2 81 Hb 14 g/dl
Platelets 56x10e9/L
Leucocytes 1.90x10e9/L (Neutrophils 0.81x10e9/L) 
12 11 CR* in BM after 6 cycles 17 
Patient 2 AML 90 Hb 8.06 g/dl
Platelets 20x10e9/L
Leucocytes 1.30x10e9/L(Neutrophils 0.64x10e9/L) 
38 15 CR in BM after 7 cycles 22 
Patient 3 AML 80 Hb 7.50 g/dl
Platelets 30x10e9/L
Leucocytes 6.00x10e9/L(Neutrophils 1.44x10e9/L) 
30 19 CR in BM after 6 cycles 23 

*CR: complete remission (<5% blast in aspirate with spicules)

Disclosures

No relevant conflicts of interest to declare.

Author notes

*

Asterisk with author names denotes non-ASH members.