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01-10-2018 | Original Article

Comparative analysis of azacitidine and intensive chemotherapy as front-line treatment of elderly patients with acute myeloid leukemia

Authors: Luca Maurillo, Francesco Buccisano, Alessandra Spagnoli, Maria Teresa Voso, Luana Fianchi, Cristina Papayannidis, Gian Luca Gaidano, Massimo Breccia, Pellegrino Musto, Eleonora De Bellis, Maria Ilaria Del Principe, Monia Lunghi, Federica Lessi, Giovanni Martinelli, Adriano Venditti

Published in: Annals of Hematology | Issue 10/2018

Abstract

The present observational study aimed to compare the efficacy of azacitidine (AZA) and intensive chemotherapy (IC) in elderly patients with untreated acute myeloid leukemia (AML), diagnosed according to WHO criteria. In the two groups, we evaluated complete remission (CR), overall survival (OS), and disease-free survival (DFS). The AZA group included 89 patients; median age was 73 years (range 61–80) and median white blood cell count (WBCc) 2.5 × 10⁹/L (range 0.27–83), 45% of the patients had BM blasts ≥ 30%, and 44 (49%) had a secondary AML (sAML). Karyotype was evaluable in 69 patients: 51 (74%) had intermediate-risk abnormalities and 18 (26%) an unfavorable risk karyotype. IC group consisted of 110 patients who received an induction course with mitoxantrone, cytarabine, and etoposide, followed by two consolidation cycles including idarubicin, cytarabine, and etoposide. Median age was 67 years (range 61–78) and median WBCc 8.0 × 10⁹/L (range 0.69–258); 44 (40%) had a sAML. Karyotype was evaluable in 88 patients, 71 (81%) had intermediate risk, and 17 (19%) unfavorable risk karyotype. To minimize the effects of treatment selection bias, adjustments were made using the propensity-score matching method, which yielded 74 patient pairs. CR rate was significantly higher in IC vs AZA group (73 vs 25%, respectively) (p < 0.0001), but the 3-year OS rates and median OS were not significantly different (21.6 vs 11% and 15.8 vs 13 months, respectively). Our analysis suggests similar outcomes with AZA compared to IC. Controlled, randomized clinical trials are warranted to confirm this conclusion.

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Title: Comparative analysis of azacitidine and intensive chemotherapy as front-line treatment of elderly patients with acute myeloid leukemia
Authors: Luca Maurillo
Francesco Buccisano
Alessandra Spagnoli
Maria Teresa Voso
Luana Fianchi
Cristina Papayannidis
Gian Luca Gaidano
Massimo Breccia
Pellegrino Musto
Eleonora De Bellis
Maria Ilaria Del Principe
Monia Lunghi
Federica Lessi
Giovanni Martinelli
Adriano Venditti
Publication date: 01-10-2018
Publisher: Springer Berlin Heidelberg
Published in: Annals of Hematology / Issue 10/2018
Print ISSN: 0939-5555
Electronic ISSN: 1432-0584
DOI: https://doi.org/10.1007/s00277-018-3374-x

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