Superior Long-Term Outcome With Idarubicin Compared With High-Dose Daunorubicin in Patients With Acute Myeloid Leukemia Age 50 Years and Older

医学 去甲柔比星 柔红霉素 内科学 髓系白血病 单变量分析 多元分析 不利影响 白血病 外科 阿糖胞苷
作者
Claude Gardin,Sylvie Chevret,Cécile Pautas,Pascal Turlure,Emmanuel Raffoux,Xavier Thomas,Bruno Quesnel,Thierry de Revel,Stéphane de Botton,Nathalie Gachard,Aline Renneville,Nicolas Boissel,Claude Preudhomme,Christine Terré,Pierre Fenaux,Dominique Bordessoule,Karine Celli‐Lebras,Sylvie Castaigné,Hervé Dombret
出处
期刊:Journal of Clinical Oncology [Lippincott Williams & Wilkins]
卷期号:31 (3): 321-327 被引量:74
标识
DOI:10.1200/jco.2011.40.3642
摘要

Although standard chemotherapy remains associated with a poor outcome in older patients with acute myeloid leukemia (AML), it is unclear which patients can survive long enough to be considered as cured. This study aimed to identify factors influencing the long-term outcome in these patients.The study included 727 older patients with AML (median age, 67 years) treated in two idarubicin (IDA) versus daunorubicin (DNR) Acute Leukemia French Association trials. Prognostic analysis was based on standard univariate and multivariate models and also included a cure fraction model to focus on long-term outcome.Age, WBC count, secondary AML, Eastern Cooperative Oncology Group (ECOG) performance status (PS), and adverse-risk and favorable-risk AML subsets (European LeukemiaNet classification) all influenced complete remission (CR) rate and overall survival (OS). IDA random assignment was associated with higher CR rate, but not with longer OS (P = .13). The overall cure rate was 13.3%. Older age and ECOG-PS more than 1 negatively influenced cure rate, which was higher in patients with favorable-risk AML (39.1% v 8.0% in adverse-risk AML; P < .001) and those treated with IDA (16.6% v 9.8% with DNR; P = .018). The long-term impact of IDA was still observed in patients younger than age 65 years, although all of the younger patients in the DNR control arm received high DNR doses (cure rate, 27.4% for IDA v 15.9% for DNR; P = .049). In multivariate analysis, IDA random assignment remained associated with a higher cure rate (P = .04), together with younger age and favorable-risk AML, despite not influencing OS (P = .11).In older patients with AML, younger age, favorable-risk AML, and IDA treatment predict a better long-term outcome.

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