Treatment of elderly patients with acute myeloid leukemia: personal experience
https://doi.org/10.17650/1818-8346-2024-19-4-14-22
Abstract
Background. Acute myeloid leukemia (AML) is an aggressive malignancy of the hematopoietic system. Most patients with newly diagnosed AML are 65 years of age or older. Treatment of this cohort of patients is difficult due to the comorbidity of elderly patients and the genetic characteristics of hemoblastosis, which prevents the achievement of significant progress in treatment, in contrast to younger patients with AML. As domestic and foreign studies have shown, age is an independent universal prognosis factor for AML. In the era of targeted drugs, successful treatment of AML is becoming possible.
Aim. To assess overall survival in elderly patients with AML, tolerability and effectiveness of various treatment regimens in patients with AML ≥65 years.
Materials and methods. This paper presents our own experience in the treatment of elderly patients with AML in the hematology departments of the City Clinical Hospital No. 52. The study included patients over 65 years of age with AML from April 2022 to September 2023. A total of 40 patients were analyzed. To determine the risk factors for death, univariate and multivariate regression analyzes were performed using the logistic regression method. Variables that showed statistical significance on univariate analysis were included in the multivariate analysis. An analysis of 12‑month overall survival was also carried out using the Kaplan–Meier method with the construction of survival curves and calculation of median survival. A comparative analysis of two groups of patients treated with the AZA + EN and LdaraC regimens was carried out.
Results. 63 % (n = 25) are men, 37 % (n = 15) are women. The median age was 75 years; all patients had complicated premorbid background. 53 % (n = 21) of patients were in the age range from 65 to 69 years, 47 % (n = 19) were over 70. Antitumor treatment was received by 88 % (n = 35) of patients. The remaining 5 underwent: best accompanying (n = 2), cytoreductive (early death at this stage) (n = 3) therapy. Complete remission after two cycles of therapy was achieved in 46 % (n = 16) of patients, and in 29 % (n = 10) it was maintained at the time of analysis. Early relapse occurred in 14 % (n = 5). Early mortality was recorded in 9 % (n = 3). Death was reported in 40 % (n = 16) of patients. 20 % (n = 7) of patients were refractory to first-line therapy, of which 36 % (n = 5) were treated with low doses of cytarabine (LdaraC), the rest to a combination of azacitidine (AZA) with venetoclax (EN). The number of relapses among patients on AZA + EN and LdaraC therapy was comparable.
Conclusion. AZA + EN is the first-line treatment of choice in older patients with AML. The possibility of conducting this course in an outpatient setting makes it most convenient for both hematologists and patients. An important aspect in the treatment of AML in elderly patients is improving and maintaining quality of life.
About the Authors
L. T. ShimanovskayaRussian Federation
3 Pekhotnaya St., Moscow 123182
E. N. Misyurina
Russian Federation
3 Pekhotnaya St., Moscow 123182;
Build. 2, 8 Trubetskaya St., Moscow 119991
E. A. Baryakh
Russian Federation
3 Pekhotnaya St., Moscow 123182;
Build. 2, 8 Trubetskaya St., Moscow 119991;
Build. 1, 2/1 Barrikadnaya St., Moscow 125993;
1 Ostrovityanova St., Moscow 117513
E. I. Zhelnova
Russian Federation
3 Pekhotnaya St., Moscow 123182;
Build. 2, 8 Trubetskaya St., Moscow 119991
K. V. Yatskov
Russian Federation
3 Pekhotnaya St., Moscow 123182
T. S. Chudnova
Russian Federation
3 Pekhotnaya St., Moscow 123182;
Build. 2, 8 Trubetskaya St., Moscow 119991
T. N. Tolstykh
Russian Federation
3 Pekhotnaya St., Moscow 123182;
Build. 2, 8 Trubetskaya St., Moscow 119991
D. E. Gagloeva
Russian Federation
3 Pekhotnaya St., Moscow 123182;
Build. 2, 8 Trubetskaya St., Moscow 119991
References
1. Shallis R.M., Wang R., Davidoff A. еt al. Epidemiology of acute myeloid leukemia: recent progress and enduring challenges. Blood Rev 2019;36:70–87. DOI: 10.1016/j.blre.2019.04.005
2. Döhner H., Weisdorf D.J., Bloomfield C.D. Acute myeloid leukemia. N Engl J Med 2015;373(12):1136–52. DOI: 10.1056/NEJMra1406184
3. Döhner H., Estey E., Grimwade D. Diagnosis and management of AML in adults: 2017 ELN recommendations from an international expert panel. Blood 2017;129(4):424–47. DOI: 10.1182/blood-2016-08-733196
4. Juliusson G., Antunovic P., Derolf A. et al. Age and acute myeloid leukemia: real world data on decision to treat and outcomes from the Swedish Acute Leukemia Registry. Blood 2009;113:4179–87. DOI: 10.1182/blood-2008-07-172007
5. Cashen A.F., Schiller G.J., O’Donnell M.R., DiPersio J.F. Multicenter, phase II study of decitabine for the firstline treatment of older patients with acute myeloid leukemia. J Clin Oncol 2010;28(4):556–61. DOI: 10.1200/JCO.2009.23.9178
6. Welch J.S., Petti A.A., Miller C.A. et al. TP53 and decitabine in acute myeloid leukemia and myelodysplastic syndromes. N Engl J Med 2016;375(21):2023–36. DOI: 10.1056/NEJMoa1605949
7. Coombs C.C., Tallman M.S., Levine R.L. Molecular therapy for acute myeloid leukaemia. Nat Rev Clin Oncol 2016;13(5):305–18. DOI: 10.1038/nrclinonc.2015.210
8. Bohl S.R., Bullinger L., Rücker F.G. New targeted agents in acute myeloid leukemia: new hope on the rise. Int J Mol Sci 2019;20(8):1983. DOI: 10.3390/ijms20081983
9. Pollyea D.A., Pratz K., Letai A. et al. Venetoclax with azacitidine or decitabine in patients with newly diagnosed acute myeloid leukemia: long term followup from a phase 1b study. Am J Hematol 2021;96(2):208–17. DOI: 10.1002/ajh.26039
10. DiNardo C.D., Jonas B.A., Pullarkat V. et al. Azacitidine and venetoclax in previously untreated acute myeloid leukemia. N Engl J Med 2020;383(7):617–29. DOI: 10.1056/NEJMoa2012971
11. Granatkin M.A., Nikitin E.A., Mikhailov E.S. et al. Azacitidine/ venetoclax combination as firstline therapy in elderly patients with acute myeloid leukemias: a first step. Klinicheskaya onkogematologiya = Clinical oncohematology. 2022;15(3):282–8. (In Russ.). DOI: 10.21320/2500-2139-2022-15-3-282-288
12. DiNardo C.D., Pratz K., Pullarkat V. et al. Venetoclax combined with decitabine or azacitidine in treatmentnaive, elderly patients with acute myeloid leukemia. Blood 2019;133(1):7–17. DOI: 10.1182/blood-2018-08-868752
Review
For citations:
Shimanovskaya L.T., Misyurina E.N., Baryakh E.A., Zhelnova E.I., Yatskov K.V., Chudnova T.S., Tolstykh T.N., Gagloeva D.E. Treatment of elderly patients with acute myeloid leukemia: personal experience. Oncohematology. 2024;19(4):14-22. (In Russ.) https://doi.org/10.17650/1818-8346-2024-19-4-14-22