Researchers classify induction therapy for patients with newly diagnosed acute myeloid leukemia (AML) as intensive or nonintensive. Because of tolerability concerns for patients older than 65 years, nonintensive therapies are increasingly used.
Mohamed L. Sorror, MD, MSc, Fred Hutchinson Cancer Research Center, University of Washington in Seattle, and colleagues sought to analyze the relationships between the factors associated with the relative benefit-risk ratios for intensive and nonintensive therapies for AML. These factors include age, comorbidities, and disease-related characteristics, such as cytogenetic and molecular features. Their research was presented at the 58th American Society of Hematology Annual Meeting and Exposition in San Diego, CA.
The authors examined data from six academic centers for 1,295 patients with newly diagnosed AML who received induction therapy between 2008 and 2012. Using two previously validated models to define distinct prognostic groups, researchers compared two-year mortality rates according to whether patients had been given intensive or nonintensive therapy.
Nonintensive therapy principally included azacitidine, decitabine, or low-dose cytarabine, whereas intensive therapies primarily included the standard 7+3 regimen or high-dose cytarabine combinations with anthracyclines or purine analogs.
Most patients were between the ages of 60 and 69; living patients had a median follow-up time of 41 months. Induction treatments were intensive in 77% and nonintensive in 23% of patients. Moreover, the percentage of patients receiving nonintensive therapy increased with increasing age.
The researchers found that patients had better survival rates if they received intensive therapy. Notably, 41% of patients aged 70–79 received intensive therapy, whereas 59% received nonintensive therapy, and the intensively treated patients in this age range had statistically significantly higher survival rates at two years (26% versus 13%).
“After accounting for underlying prognosis using two validated models, we found patients with newly diagnosed AML generally had better survival if they received intensive therapy,” Sorror said. Moreover, early mortality for patients given intensive versus nonintensive therapy did not increase in age, “likely due to improvements in supportive care which allowed the greater anti AML effect of intensive therapy to become manifest over time.”
“Our results suggest intensive therapy could be considered for most patients up to the age of 80 years, regardless of their comorbidity burden,” Sorror said.