Outcome of older patients with acute myeloid leukemia in first relapse
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 (...
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Published in | American journal of hematology Vol. 88; no. 9; pp. 758 - 764 |
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Main Authors | , , , , , , , , , , , , , , , , |
Format | Journal Article |
Language | English |
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United States
Wiley Subscription Services, Inc
01.09.2013
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ISSN | 0361-8609 1096-8652 1096-8652 |
DOI | 10.1002/ajh.23498 |
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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. Am. J. Hematol. 88:758–764, 2013. © 2013 Wiley Periodicals, Inc. |
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AbstractList | 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. Am. J. Hematol. 88:758–764, 2013. © 2013 Wiley Periodicals, Inc. 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. Am. J. Hematol. 88:758–764, 2013. © 2013 Wiley Periodicals, Inc. 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. Am. J. Hematol. 88:758-764, 2013. © 2013 Wiley Periodicals, Inc. [PUBLICATION 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. 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.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. |
Author | Turlure, Pascal Micol, Jean‐Baptiste Malfuson, Jean‐Valère Dombret, Hervé Sarkozy, Clémentine Thomas, Xavier Fenaux, Pierre Chevret, Sylvie Merabet, Fathia Celli‐Lebras, Karine Terré, Christine Castaigne, Sylvie Pautas, Cécile Gardin, Claude Preudhomme, Claude Quesnel, Bruno Gachard, Nathalie |
Author_xml | – sequence: 1 givenname: Clémentine surname: Sarkozy fullname: Sarkozy, Clémentine organization: University Versailles ‐ Saint Quentin – sequence: 2 givenname: Claude surname: Gardin fullname: Gardin, Claude organization: University Paris 13 – sequence: 3 givenname: Nathalie surname: Gachard fullname: Gachard, Nathalie organization: University Limoges – sequence: 4 givenname: Fathia surname: Merabet fullname: Merabet, Fathia organization: University Versailles ‐ Saint Quentin – sequence: 5 givenname: Pascal surname: Turlure fullname: Turlure, Pascal organization: University Limoges – sequence: 6 givenname: Jean‐Valère surname: Malfuson fullname: Malfuson, Jean‐Valère organization: Hôpital d'Instruction des Armées – sequence: 7 givenname: Cécile surname: Pautas fullname: Pautas, Cécile organization: University Paris 12 – sequence: 8 givenname: Jean‐Baptiste surname: Micol fullname: Micol, Jean‐Baptiste organization: University Paris 7 – sequence: 9 givenname: Xavier surname: Thomas fullname: Thomas, Xavier organization: Hôpital Lyon Sud – sequence: 10 givenname: Bruno surname: Quesnel fullname: Quesnel, Bruno organization: University Lille – sequence: 11 givenname: Karine surname: Celli‐Lebras fullname: Celli‐Lebras, Karine organization: University Paris 7 – sequence: 12 givenname: Claude surname: Preudhomme fullname: Preudhomme, Claude organization: University Lille – sequence: 13 givenname: Christine surname: Terré fullname: Terré, Christine organization: University Versailles ‐ Saint Quentin – sequence: 14 givenname: Pierre surname: Fenaux fullname: Fenaux, Pierre organization: University Paris 13 – sequence: 15 givenname: Sylvie surname: Chevret fullname: Chevret, Sylvie organization: University Paris 7 – sequence: 16 givenname: Sylvie surname: Castaigne fullname: Castaigne, Sylvie organization: University Versailles ‐ Saint Quentin – sequence: 17 givenname: Hervé surname: Dombret fullname: Dombret, Hervé organization: University Paris 7 |
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Notes | Conflict of interest: Nothing to report C.S. and C.G. contributed equally to this work. ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 ObjectType-Article-2 ObjectType-Feature-1 content type line 23 |
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Snippet | 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... |
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SubjectTerms | Age Factors Aged Aminoglycosides - administration & dosage Antibodies, Monoclonal, Humanized - administration & dosage Antineoplastic Combined Chemotherapy Protocols - therapeutic use Cytarabine - administration & dosage Female Hematology Humans Karyotyping Leukemia, Myeloid, Acute - mortality Leukemia, Myeloid, Acute - therapy Male Medical research Medical treatment Middle Aged Recurrence Remission Induction - methods Salvage Therapy - methods Survival Analysis Treatment Outcome |
Title | Outcome of older patients with acute myeloid leukemia in first relapse |
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