General AML

High-intensity chemotherapy versus palliative chemotherapy in patients over 60 years with Acute Myeloid Leukemia

The prognosis of elderly patients with Acute Myeloid Leukemia (AML) is poor. Furthermore, the majority of AML patients are over 60 years of age and as a result more effective treatment options are needed to serve and improve outcomes of this patient population. The use of High-intensity Chemotherapy (HIC) may be of benefit to these patients, however the use of HIC in elderly patients is divisive. Medrano-Contreras J. et al. analyzed the use of HIC in elderly AML patients in comparison with palliative chemotherapy.

Their results were originally published in Spanish in Rev Med Inst Mex Seguro Soc. in 2016

The key results were:
  HIC Palliative Chemotherapy
CR n = 7 n = 1
Deaths n = 1  
Median survival in months 13.25 3.35

In conclusion, this is clearly an exploratory study owing to the very small sample size investigated. Although there are some encouraging results regarding the potential benefits of using HIC in elderly patients and an unfortunate adverse event leading to death of a patient using HIC, it is imperative to perform large scale randomized studies to confirm its benefits and proper management of adverse events. However, this study provides a useful basis for further exploration of HIC for this unmet medical need.

Abstract
BACKGROUND:

The use of high-intensity chemotherapy (HIC) for acute myeloid leukemia (AML) in the elderly is controversial. In the present study, it was assessed complete remission and overall survival of AML patients over 60 years treated with HIC or palliative chemotherapy.

METHODS:

Patients with ECOG ≤ 2 and adequate organic function received HIC with a base of cytarabine for five or seven days, and an anthracycline for three days. If patients achieved complete remission of leukemia, they received one or two cycles of consolidation with cytarabine. Palliative treatment consisted of supported measures and/or oral or intravenous low-dose chemotherapy.

RESULTS:

Seven patients treated with HIC achieved complete remission versus only one in the palliative group. Only one patient died during HIC treatment. Median survival for HIC-treated patients was 13.25 months, and only 3.35 months for patients treated with palliative therapy (p < 0.05).

CONCLUSION:

AML patients of 60 years or older, with good performance status (ECOG ≤ 2) and adequate organ function, may benefit from HIC treatment, with better survival, compared with palliative therapy.

References
  1. Medrano-Contreras J. et al. High-intensity chemotherapy versus palliative chemotherapy in patients over 60 years with acute myeloid leukemia. Rev Med Inst Mex Seguro Soc. 2016; 54 Suppl 2:S148-S155.