Outcome of older patients with acute myeloid leukemia in first relapse
Clémentine Sarkozy, Claude Gardin, Nathalie Gachard, Fathia Merabet, Pascal Turlure, Jean-Valère Malfuson, Cécile Pautas, Jean-Baptiste Micol, Xavier Thomas, Bruno Quesnel, Karine Celli-Lebras, Claude Preudhomme, Christine Terré, Pierre Fenaux, Sylvie Chevret, Sylvie Castaigne, Hervé Dombret, Clémentine Sarkozy, Claude Gardin, Nathalie Gachard, Fathia Merabet, Pascal Turlure, Jean-Valère Malfuson, Cécile Pautas, Jean-Baptiste Micol, Xavier Thomas, Bruno Quesnel, Karine Celli-Lebras, Claude Preudhomme, Christine Terré, Pierre Fenaux, Sylvie Chevret, Sylvie Castaigne, Hervé Dombret
Abstract
To provide data for future drug evaluation, we analyzed the outcome of 393 patients aged 50 years or older (median, 64 years) with AML in first relapse after treatment in recent ALFA trials. Salvage options were retrospectively classified as follows: best supportive care (BSC), low-dose cytarabine (LDAC), gemtuzumab ozogamicin (GO), intensive chemotherapy (ICT), or ICT combined with GO. Second complete remission (CR2) rate was 31% and median post-relapse survival was 6.8 months (0, 17, 42.5, 53, and 80% and 3.2, 5.6, 8.9, 9, and 19.8 months in BSC, LDAC, GO, ICT, and ICT + GO subsets, respectively). Age, performance status, WBC, CR1 duration, and favorable AML karyotype, but not other cytogenetic or molecular features, influenced post-relapse outcome. Multivariate adjustment and propensity score matching showed that intensive salvage (ICT/ICT+GO/GO versus LDAC/BSC) was associated with longer post-relapse survival, at least in patients with CR1 duration ≥12 months (P = 0.001 and 0.0005, respectively). Of interest, GO appeared to be as effective as standard ICT, and ICT + GO combination more effective than standard ICT. In conclusion, older patients with CR1 duration ≥12 months appeared to benefit from intensive salvage and results observed with GO-containing salvage suggest that GO combination studies should be actively pursued in this setting.
Trial registration: ClinicalTrials.gov NCT00363025 NCT00931138.
Copyright © 2013 Wiley Periodicals, Inc.
Source: PubMed