IMEX   05356
INSTITUTO DE MEDICINA EXPERIMENTAL
Unidad Ejecutora - UE
congresos y reuniones científicas
Título:
HYPOMETHYLATING AGENTS OR INTENSIVE CHEMOTHERAPY FOR ELDERLY AML PATIENTS: INFLUENCING FACTORS ON THERAPY SELECTION AND THEIR IMPACT ON THE OUTCOME IN THE ARGENTINE REAL-WORLD
Autor/es:
MELA OSORIO, MARIA JOSE; DICK, HERNÁN; GONZALEZ, JACQUELINE; MOIRANO, MARÍA; GIMENEZ CONCA, ALBERTO; BELLI, CAROLINA; CRANCO, SANTIAGO; SUERO, ALEJANDRO; NAVICKAS, ALICIA; LAZZARINO, CAROLINA; FERNANDEZ, ISOLDA; RAPAN, LETICIA; OLIVEIRA, NATALIA; KORNBLIHTT, LAURA
Lugar:
Madrid (Virtual)
Reunión:
Congreso; 25th Congress of the European Hematology Association; 2020
Institución organizadora:
European Hematology Association
Resumen:
Background: Acute myeloid leukemia (AML) over 65 years has a particularly poor prognosis due to its clinical and biological features. In Argentina the main therapeutic options are hypomethylating agents (HMA) [Azacitidine (AZA) or Decitabine (DAC)] and intensive chemotherapy (CMT).Aims: To examine clinical factors that influenced the choice between HMA and CMT and the impact of the selection on the outcome of elderly patients (pts) from an Argentine real-world setting.Methods: This was a retrospective analysis of 728 AML pts from the Argentine Society of Hematology database including patients from 11 centers. Responses were evaluated according to the ELN2017 criteria for intensive CMT and to IWGMDS 2006 criteria for HMA. Statistical analysis included Fisher?s exact test/ chi2, Kaplan Meier/log-rank test and Cox regression for survival, censoring or not at other treatments, to the last follow-up or death.Results: One hundred and forty-five pts (20%) ≥65 years old received first-line treatment with HMA or intensive CMT between Jan-13/May-19. Sex ratio M/F was 1.3 (83/62) with a median age of 70.6 years (interquartile range-IQR 67.8- 76.0). First-line therapy included 87 (61%) with HMA and 57 (39%) with CMT. This selection was influenced by an age >75 years: HMA 40 (46%) vs CMT 6 (10.3%), p50%: HMA 31 (35.6%) vs CMT 32 (55%) p= 0.026. Median follow-up was 8 months and median time from diagnosis to treatment initiation was 7 days. Regarding responses to HMA, with a median of 6 cycles (range 1-30), the overall rate was 40% (n=35) and achieved transfusion independence 45%(n=39). On those treated with intensive CMT, 54% (n=31) obtained Complete Remission (CR), subsequently 27 pts (47%) received 1 to 3 consolidation cycles with high doses of CMT. Relapsed was observed in 13 pts within a median time of 8.2m. During the follow-up, 70.3% died (n=102) (HMA, n=64 [73%] and CMT, n=38 [66.6%]) with a median overall survival (OS) of 11.3 and 8.5 m under HMA and CMT, respectively; p=0.46. A total of 7 pts (8%) in the HMA group and24 pts (65%) in the CMT group received subsequent treatment for AML after the 1st line, including: cytarabine-based regimen (2.3% and 18% respectively), DAC (5.6% in AZA group) and AZA (47% in CMT group). A minority of 9 pts (6.2%) (4 [4.6%] HMA and 5 [13.5%] CMT) underwent hematopoietic stem cell transplantation. The main variable associated with survival in both 1st line schemes was to obtain a treatment response. Particularly, among those treated with HMA, the multivariate analysis confirmed the favorable outcome of those patients who responded: 21.2m (vs 8.0m),HR 8.5 (95% IC 3.7-19.6), p