Outcomes and survival predictors of Latin American older adults with acute myeloid leukemia: Data from a single center

ABSTRACT Introduction: Acute myeloid leukemia (AML) is most commonly presented in older adults; however, it appears 10 years earlier in Latin American countries. Clinical evolution in older adults from this populations has not been characterized. We analyzed outcomes and survival predictors. Methods: Patients ≥ 55 years old diagnosed with AML at a hematology referral center from 2005 to 2020 receiving intensive chemotherapy (IC), low-dose cytarabine (LDAC) and best supportive care (BSC) were included. Survival analysis included the Kaplan-Meier and Cox models and the cumulative incidence of relapse (CIR). Results: Seventy-five adults were included and the overall survival (OS) was 4.87, 1.67 and 1.16 months, using IC, LDAC and BSC, respectively. The IC led to a higher OS (p < 0.001) and was a protective factor for early death, at a cost of more days spent hospitalized and more non-fatal treatment complications; non-significant differences were found between the LDAC and BSC. Eight (10.7%) patients underwent hematopoietic cell transplantation, with a higher OS (p = 0.013). Twenty (26.7%) patients achieved complete remission; 12 (60%) relapsed with a 6-month CIR of 57.9% in those < 70 years old vs. 86.5% in those ≥ 70 years old, p = 0.034. Multivariate analysis showed the white blood cell count (WBC) and IC had a significant impact on the patient survival, whereas chronological age and the Charlson comorbidity index (CCI) did not. Conclusion: AML in low-middle income countries demands a different approach; the IC improves survival, even with a high incidence of relapse, and should be offered as first-line treatment. Eligibility criteria should include WBC and a multidimensional evaluation. The age per se and the CCI should not be exclusion criteria to consider IC.

Standard Induction Followed by Low Dose Cytarabine for the Treatment of Acute Myeloid Leukemia of Down Syndrome / 임상소아혈액종양

BACKGROUND: Although acute myeloid leukemia occurring in patients with Down syndrome (AML-DS) is generally chemosensitive, these patients are more susceptible to regimen-related toxicities, and the optimal post-remission therapy for AML-DS is unknown. This study aimed to evaluate the outcome of post-remission chemotherapy using low dose cytarabine for AML-DS. METHODS: We reviewed the medical records of 142 patients who were newly diagnosed as de novo AML between 1996 and 2011. Among them, 8 patients (5.6%) had Down syndrome. Seven patients received standard induction therapy composed of cytarabine (or behenoyl cytarabine) and anthracycline. Once complete remission (CR) was achieved, repetitive courses of low dose cytarabine were given. RESULTS: Patients' median age at diagnosis was 1.3 years (range, 0.4-1.9). All but one showed French-American-British (FAB) M7 morphology. Six patients achieved CR (75%) after induction therapy and then received 9 to 20 courses (median, 14) of low dose cytarabine. One patient had 2 episodes of neutropenic fever, whereas the other 5 patients did not suffer from any complication. All six patients are alive event-free with a median follow-up of 118 months (range, 33-208). The estimated 5-year overall survival of all 8 AML-DS patients was 87.5%, while that of non-DS de novo AML patients was 58.6% (P=0.18). CONCLUSION: Low dose cytarabine was safe and effective as a post-remission therapy for AML-DS. Due to the rarity of AML-DS, a multicenter cooperative study is essential to identify the optimal duration of treatment and to further determine the feasibility of low dose cytarabine for these patients.

Standard Induction Followed by Low Dose Cytarabine for the Treatment of Acute Myeloid Leukemia of Down Syndrome / 임상소아혈액종양

BACKGROUND: Although acute myeloid leukemia occurring in patients with Down syndrome (AML-DS) is generally chemosensitive, these patients are more susceptible to regimen-related toxicities, and the optimal post-remission therapy for AML-DS is unknown. This study aimed to evaluate the outcome of post-remission chemotherapy using low dose cytarabine for AML-DS.METHODS: We reviewed the medical records of 142 patients who were newly diagnosed as de novo AML between 1996 and 2011. Among them, 8 patients (5.6%) had Down syndrome. Seven patients received standard induction therapy composed of cytarabine (or behenoyl cytarabine) and anthracycline. Once complete remission (CR) was achieved, repetitive courses of low dose cytarabine were given.RESULTS: Patients' median age at diagnosis was 1.3 years (range, 0.4-1.9). All but one showed French-American-British (FAB) M7 morphology. Six patients achieved CR (75%) after induction therapy and then received 9 to 20 courses (median, 14) of low dose cytarabine. One patient had 2 episodes of neutropenic fever, whereas the other 5 patients did not suffer from any complication. All six patients are alive event-free with a median follow-up of 118 months (range, 33-208). The estimated 5-year overall survival of all 8 AML-DS patients was 87.5%, while that of non-DS de novo AML patients was 58.6% (P=0.18).CONCLUSION: Low dose cytarabine was safe and effective as a post-remission therapy for AML-DS. Due to the rarity of AML-DS, a multicenter cooperative study is essential to identify the optimal duration of treatment and to further determine the feasibility of low dose cytarabine for these patients.

Clinical Characteristics and Therapeutic Efficacy of Low Dose Cytarabine in High Risk Myelodysplastic Syndrome / 대한혈액학회지

BACKGROUND: High risk myelodysplastic syndrome has various clinical courses and refractoriness to various therapies. It is important to analyze clinical characteristics and therapeutic responses in high risk myelodysplastic syndrome. METHODS: Sixty nine cases of primary high risk myelodysplastic syndrome at diagnosis were enrolled in this study at Kyungpook National University Hospital and Taegu Hyosung- Catholic University Hospital from January 1987 to June 1996. We have investigated the clinical characteristics and therapeutic outcomes after low dose cytarabine chemotherapy. RESULTS: 1) The median age of the patients was 48 years. Male to female ratio was 2.1:1. The each numbers of RAEB, CMML and RAEB-T patients were 38, 11 and 20, respectively. 2) The most common chief complaint was dyspnea on exertion. General weakness, fever and dizziness were also observed. The most common physical finding was pallor. 3) The peripheral blood findings showed anemia in 65 cases (94.2%), thrombocytopenia in 64 cases (92.8%), leukopenia in 32 cases (46.4%) and pancytopenia in 26 cases (37.7%). 4) Twenty two cases transformed to acute myelogenous leukemia during the follow-up periods. Chemotherapy was done in 18 cases among 22 cases of transformed acute myelogenous leukemia. Complete remission was achieved in 3 cases (16.7%), partial remission in 4 cases (22.2%) and no response in 11 cases (61.1%). 5) Forty seven cases were treated by low dose cytarabine chemotherapy. Complete response was achieved in 11 cases (23.4%), partial response in 13 cases (27.7%) and no response in 23 cases (48.9%). Median duration of complete response was 12 weeks. 6) We made score system, which based on Sanz score and Gattermann score, according to age, hemoglobin, platelet and bone marrow blast. Overall survival was higher in group A (score or = 6). Complete response of low dose cytarabine chemotherapy was higher in group A than group B but overall survival according to low dose cytarabine chemotherapy was not different in group A and group B. CONCLUSION: Low dose cytarabine chemotherapy was not effective in survival benefit. Score system according to prognostic factors was important to predict therapeutic response and prognosis. In the future, more intensive therapeutic plan and analysis of prognostic factors should be considered.