Identification of Predictive Factors for Overall Survival and Response during Hypomethylating Treatment in Very Elderly (≥75 Years) Acute Myeloid Leukemia Patients: A Multicenter Real-Life Experience

Matteo Molica, Carla Mazzone, Pasquale Niscola, Ida Carmosino, Ambra Di Veroli, Cinzia De Gregoris, Fabrizio Bonanni, Salvatore Perrone, Natalia Cenfra, Luana Fianchi, Anna Lina Piccioni, Antonio Spadea, Giovanni Luzi, Andrea Mengarelli, Laura Cudillo, Luca Maurillo, Livio Pagano, Massimo Breccia, Luigi Rigacci, Paolo De Fabritiis

Risultato della ricerca: Contributo in rivistaArticolo in rivista

Abstract

Simple Summary Intensive induction strategies are rarely used for older patients in community on-cology practice, with comorbidities being the major cause of contraindication. We conducted a multicentric retrospective study to evaluate activity and safety in a real-life setting of hypomethylating drugs (HMAs) in patients older than 75 years with AML. In multivariate analysis, age (>= 80), Charlson comorbidity index (>= 3), creatinine clearance and the type of best response (>= PR) during treatment maintained independent significance in predicting survival. Furthermore, our data show that HMAs have similar efficacy compared to pivotal trials and are well tolerated in a setting of very elderly patients with several co-comorbidities. Elderly patients represent the most challenging and hard-to-treat patient population due to dismal characteristics of the disease, such as secondary-acute myeloid leukemia (AML), enrichment of unfavorable molecular genes (TP53) and comorbidities. We conducted a multicentric retrospective study to evaluate activity and safety in a real-life setting of hypomethylating drugs (HMAs) in patients older than 75 years with AML. Between September 2010 and December 2021, 220 patients were treated, 164 (74.5%) received AZAcitidine and 56 DECitabine; most patients (57.8%), received more than four cycles of HMAs. The best response obtained was CR in 51 patients (23.2%), PR in 23 (10.5%) and SD in 45 (20.5%); overall transfusion independence was obtained in 47 patients (34%), after a median of 3.5 months. The median OS (mOs) was 8 months (95% CI 5.9-10.2), with 1- and 2-years OS of 39.4% (95% CI 32.7-46) and 17.4% (95% CI 11.7-23.1), respectively; similar mOS was observed according to HMA treatment (AZA 8.3 vs. DEC 7.8 months, p = 0.810). A subset of 57 long survivors (44 in AZA group and 13 in DEC group) received at least 12 cycles of HMAs, their mOS was 24.3 months. In multivariate analysis, age (>= 80), Charlson comorbidity index (>= 3), creatinine clearance and the type of best response (>= PR) during treatment maintained independent significance in predicting survival. Infectious complications, most frequently pneumonia (35) and septic shock (12), were lethal in 49 patients (22.2%). Our data show that HMAs have similar efficacy compared to pivotal trials and are well tolerated in a setting of very elderly patients with several co-comorbidities.
Lingua originaleEnglish
pagine (da-a)4897-4903
Numero di pagine7
RivistaCancers
Volume14
DOI
Stato di pubblicazionePubblicato - 2022

Keywords

  • acute myeloid leukemia
  • real-life experience
  • very elderly

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