Multisite 11-year experience of less-intensive vs intensive therapies in acute myeloid leukemia

被引：39

作者：

Sorror, Mohamed L. ^{[1
,2
]}

Storer, Barry E. ^{[3
,4
]}

Fathi, Amir T. ^{[5
]}

Brunner, Andrew ^{[5
]}

Gerds, Aaron T. ^{[6
]}

Sekeres, Mikkael A. ^{[6
]}

Mukherjee, Sudipto ^{[6
]}

Medeiros, Bruno C. ^{[7
]}

Wang, Eunice S. ^{[8
]}

Vachhani, Pankit ^{[8
]}

Shami, Paul J. ^{[9
]}

Pena, Esteban ^{[9
]}

Elsawy, Mahmoud ^{[1
,10
]}

Adekola, Kehinde ^{[11
]}

Luger, Selina ^{[12
]}

Baer, Maria R. ^{[13
]}

Rizzieri, David ^{[14
]}

Wildes, Tanya M. ^{[15
]}

Koprivnikar, Jamie ^{[16
]}

Smith, Julie ^{[17
]}

Garrison, Mitchell ^{[17
]}

Kojouri, Kiarash ^{[18
]}

Leisenring, Wendy ^{[3
]}

Onstad, Lynn ^{[3
]}

Nyland, Jennifer E. ^{[19
]}

Becker, Pamela S. ^{[1
,20
]}

McCune, Jeannine S. ^{[1
,21
]}

Lee, Stephanie J. ^{[1
,2
]}

Sandmaier, Brenda M. ^{[1
,2
]}

Appelbaum, Frederick R. ^{[1
,2
]}

Estey, Elihu H. ^{[1
,20
]}

机构：

[1] Fred Hutchinson Canc Res Ctr, Clin Res Div, D5-285,1100 Fairview Ave North, Seattle, WA 98109 USA

[2] Univ Washington, Sch Med, Dept Med, Div Med Oncol, Seattle, WA 98195 USA

[3] Fred Hutchinson Canc Res Ctr, Clin Res Div, Clin Stat Program, 1124 Columbia St, Seattle, WA 98104 USA

[4] Univ Washington, Sch Publ Hlth, Dept Biostat, Seattle, WA 98195 USA

[5] Harvard Med Sch, Massachusetts Gen Hosp, Boston, MA 02115 USA

[6] Cleveland Clin, Leukemia & Myeloid Disorders Program, Cleveland, OH 44106 USA

[7] Stanford Univ, Dept Med, Div Hematol, Stanford, CA 94305 USA

[8] Roswell Pk Canc Inst, Buffalo, NY USA

[9] Univ Utah, Huntsman Canc Inst, Div Hematol & Hematol Malignancies, Salt Lake City, UT USA

[10] Dalhousie Univ, Dept Med, Div Hematol, Halifax, NS, Canada

[11] Northwestern Univ, Feinberg Sch Med, Robert H Lurie Comprehens Canc Ctr, Chicago, IL 60611 USA

[12] Univ Penn, Abramson Canc Ctr, Philadelphia, PA 19104 USA

[13] Univ Maryland, Greenebaum Comprehens Canc Ctr, Baltimore, MD 21201 USA

[14] Duke Univ, Med Ctr, Div Hematol Malignancies & Cellular Therapy, Durham, NC USA

[15] Washington Univ, Sch Med, Div Oncol, St Louis, MO USA

[16] Hackensack Univ Med Ctr, John Theurer Canc Ctr, Hackensack, NJ USA

[17] Confluence Hlth, Wenatchee Valley Hosp & Clin, Wenatchee, WA USA

[18] Skagit Valley Hosp, Mt Vernon, WA USA

[19] Penn State Coll Med, Hershey, PA USA

[20] Univ Washington, Sch Med, Dept Med, Div Hematol, Seattle, WA 98195 USA

[21] City Hope Natl Med Ctr, Dept Populat Sci, Duarte, CA USA

来源：

BLOOD | 2021年 / 138卷 / 05期

关键词：

CONVENTIONAL CARE REGIMENS; NEWLY-DIAGNOSED AML; OLDER PATIENTS; GERIATRIC ASSESSMENT; INDUCTION CHEMOTHERAPY; GEMTUZUMAB OZOGAMICIN; COMPLETE REMISSION; ELDERLY-PATIENTS; REAL-WORLD; SURVIVAL;

D O I：

10.1182/blood.2020008812

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Less-intensive induction therapies are increasingly used in older patients with acute myeloid leukemia (AML). Using an AML composite model (AML-CM) assigning higher scores to older age, increased comorbidity burdens, and adverse cytogenetic risks, we defined 3 distinct prognostic groups and compared outcomes after less-intensive vs intensive induction therapies in a multicenter retrospective cohort (n = 1292) treated at 6 institutions from 2008 to 2012 and a prospective cohort (n = 695) treated at 13 institutions from 2013 to 2017. Prospective study included impacts of Karnofsky performance status (KPS), quality of life (QOL), and physician perception of cure. In the retrospective cohort, recipients of less-intensive therapies were older and had more comorbidities, more adverse cytogenetics, and worse KPS. Less-intensive therapies were associated with higher risks of mortality in AML-CM scores of 4 to 6, 7 to 9, and >= 10. Results were independent of allogeneic transplantation and similar in those age 70 to 79 years. In the prospective cohort, the 2 groups were similar in baseline QOL, geriatric assessment, and patient out-come preferences. Higher mortality risks were seen after less-intensive therapies. However, in models adjusted for age, physician-assigned KPS, and chance of cure, mortality risks and QOL were similar. Less-intensive therapy recipients had shorter length of hospitalization (LOH). Our study questions the survival and QOL benefits (except LOH) of less-intensive therapies in patients with AML, including those age 70 to 79 years or with high comorbidity burdens. A randomized trial in older/medically infirm patients is required to better assess the value of less-intensive and intensive therapies or their combination.

引用

页码：387 / 400

页数：14

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