Source: DGNews  |  Posted 1 year ago

WASHINGTON, DC -- July 29, 2010 -- The prognosis is poor for nearly three-quarters of elderly patients on intensive chemotherapy for acute myeloid leukaemia (AML), with a median survival of less than 6 months, according to a study published online in Blood, the journal of the American Society of Hematology. Specific risk factors can help identify which patients may benefit from the treatment.

"Recent studies have suggested that intensive chemotherapy might benefit elderly patients with AML, but we found that not to be the case," said senior author Hagop Kantarjian, MD, The University of Texas MD Anderson Cancer Center, Houston, Texas. "Patients who did not have any of the 8-week mortality predictors we identified in the study may benefit from the more intense treatment, but, for the majority of AML patients of advanced age, lower-intensity treatments are a better, less risky option."

Treatments for AML include chemotherapy or a transplant with blood cells obtained from the circulating blood or cord blood -- although, for most elderly patients, the risks of serious side effects eliminate transplant as a viable option.

As most clinical trials of AML thus far have excluded patients aged >55 years, physicians have had to infer that treatments that work for younger patients will work for older patients, too. In this study, researchers focused on older patients with AML to provide more conclusive information about treatment among this population.

The research team analysed 446 patients aged 70 years or older with AML who were treated with a cytarabine-based intensive chemotherapy regimen between 1990 and 2008. For nearly half of the patients, the therapy was successful in combating the cancer, with 45% achieving a complete remission; however, 154 patients (some who were in remission as well as some who were not) died during the first 8 weeks after treatment began. Causes of death included both treatment toxicity and ineffective therapy leading to disease progression.

The researchers analysed the patients to identify those most at risk for this 8-week mortality rate and found the following predictive factors:
· Age older then 80 years
· 3 or more genetic abnormalities
· Poor performance as indicated by an Eastern Cooperative Oncology Group (ECOG) score of 2-4
· Creatinine levels >1.3 mg

The more factors a patient had, the poorer the survival outcome with intensive chemotherapy. Among the 28% of patients who had none of these risk factors, the 8-week mortality rate was 16%, compared with a 71% mortality rate among patients with 3 or more adverse factors (9%).

"When doctors and patients are discussing intensive chemotherapy as a treatment option for AML, they must take these mortality risk factors into consideration to determine whether the patient is likely to benefit from this type of treatment," said Dr. Kantarjian.

AML is the most common form of acute leukaemia among adults and is a rapidly growing cancer of the bone marrow that requires immediate treatment. The average age at diagnosis is 67, and more than 12,000 people will be diagnosed with AML this year (according to the National Cancer Institute).

Symptoms of AML include fever, frequent infections, tiredness, pale skin, shortness of breath, easy bleeding or bruising, and pain in the bones or joints. Because the disease develops rapidly, treatment usually begins immediately after diagnosis.

SOURCE: Blood