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Calabria S, Ronconi G, Dondi L, Piccinni C, Pedrini A, Esposito I, Addesi A, Rossi G, Ferrara F, Venditti A, Martini N. Acute myeloid leukemia: Incidence, transplantation and survival through Italian administrative healthcare data. TUMORI JOURNAL 2023; 109:496-503. [PMID: 36896466 DOI: 10.1177/03008916231153698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
OBJECTIVE To identify newly diagnosed patients with acute myeloid leukemia in 2017 treated with intensive chemotherapy or unfit for intensive chemotherapy, and to assess their probability of receiving allogeneic stem cell transplantation and survival, from the Italian National Health Service perspective. PATIENTS AND METHODS From the Ricerca e Salute database, adults with an in-hospital diagnosis of acute myeloid leukemia (International Classification of Disease-9th version-Clinical Modification code 205.0x) in 2017 (index date), without any identifying acute myeloid leukemia criteria within the preceding year, were selected. Among them, subjects treated with intensive chemotherapy (chemotherapy during an overnight hospitalization) within one year after index date were identified. The remaining were considered unfit for intensive chemotherapy. Gender, age and comorbidities were described. Within the follow-up period, probabilities of in-hospital allogeneic stem cell transplantation and overall survival were assessed through Kaplan Meier analyses. RESULTS From 4,840,063 beneficiaries of the Italian National Health Service, 368 newly acute myeloid leukemia diagnosed adults (9.0 *100,000) were selected. Males comprised 57%. Mean age was 68±15. There were 197 patients treated with intensive chemotherapy. The remaining 171 unfit for intensive chemotherapy were older (72±14) and with more comorbidities (e.g. hypertension, chronic lung diseases and chronic kidney disease). Only patients treated with intensive chemotherapy underwent an allogeneic stem cell transplantation (41; 33%) during the one year after the index date. Within the first and second follow-up year, respectively: 41.1% and 26.9% of subjects treated with intensive chemotherapy (144) survived (median survival time: 7.8 months); 25.7% and 18.7% of those unfit for intensive chemotherapy (139) survived (1.2 months). Difference was significant (p<0.0001). Within one and two years after transplantation (41 patients), 73.5% and 67.3% of subjects survived, respectively. CONCLUSION This study, by showing the incidence of acute myeloid leukemia in Italy in 2017, the proportion of patients treated with intensive chemotherapy from the new diagnosis, the use of allogeneic stem cell transplantation and two-year survival, integrated evidence on large and unselected populations and may help to improve treatment strategies of older acute myeloid leukemia patients.
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Affiliation(s)
| | | | | | | | | | | | | | - Giuseppe Rossi
- Department of Hematology, ASST Spedali Civili di Brescia, Italy
| | - Felicetto Ferrara
- Department of Hematology and Stem Cell Transplantation, Ospedale Cardarelli, Italy
| | - Adriano Venditti
- Department of Hematology, University of Rome "Tor Vergata", Rome, Italy
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Bi X, Gergis U, Wagner JL, Carabasi M, Filicko-O’Hara J, O’Hara W, Klumpp T, Porcu P, Flomenberg N, Grosso D. Outcomes of two-step haploidentical allogeneic stem cell transplantation in elderly patients with hematologic malignancies. Bone Marrow Transplant 2022; 57:1671-1680. [PMID: 35986105 PMCID: PMC9388981 DOI: 10.1038/s41409-022-01780-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 08/01/2022] [Accepted: 08/03/2022] [Indexed: 11/30/2022]
Abstract
Allogeneic hematopoietic stem cell transplantation (allo-SCT) remains the best curative option for the majority of patients with hematologic malignancies (HM); however, many elderly patients are excluded from transplant and outcome data in this population is still limited. The novel two-step graft engineering approach has been the main platform for allo-SCT at Thomas Jefferson University since 2006. Following administration of the preparative regimen, we infuse donor lymphocytes, followed by cyclophosphamide to induce bidirectional tolerance, then infusion of CD34-selected cells. A total of 76 patients ≥ 65 years old with HM underwent haploidentical (haplo) allo-SCT on the two-step transplant platform between 2007 and 2021. The median time to neutrophil engraftment was 11 days and platelet engraftment was 18 days. With a median follow up of 44 months, the 3-year overall survival (OS) and progression-free survival (PFS) were 36.3% and 35.6%, respectively. The cumulative incidences of non-relapse mortality (NRM) and relapse at 3 years were 43.5% and 21.0% at 3 years, respectively. The cumulative incidence of grade III-IV acute graft-versus-host-disease (GVHD) was 11.1% at 6 months, and chronic GVHD requiring treatment was 15.1% at 2 years. The two-step haplo allo-SCT is a novel alternative platform for high-risk older HM patients, achieving fast engraftment, low relapse rates and promising survival.
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Chen Y, Cao J, Ye Y, Luo L, Zheng X, Yang X, Zheng Z, Zheng J, Yang T, Hu J. Hypomethylating agents combined with low-dose chemotherapy for elderly patients with acute myeloid leukaemia unfit for intensive chemotherapy: a real-world clinical experience. J Chemother 2022:1-8. [PMID: 35881409 DOI: 10.1080/1120009x.2022.2097433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
This study aimed to assess the efficacy and safety of hypomethylating agent (HMA)-based regimens in the treatment of older adult patients with acute myeloid leukaemia (AML), unfit for standard induction chemotherapy. Treatment outcomes and prognostic factors of 140 older adult patients with AML who were unfit for intensive chemotherapy and were treated with HMA-based therapies were retrospectively analysed. The median age of the group was 70 years, and poor-risk cytogenetics and secondary/treatment-related AML (s/t-AML) accounted for 45.6% and 34.3% of these patients, respectively. The overall response rate was 48.6%, and 40.1% for patients who achieved complete remission (CR) or CR with incomplete blood count recovery. The median overall survival (OS) was 10.4 months, and the 1-, 2-, and 5-year OS rates were 42.6%, 19.9%, and 4.9%, respectively. Early mortality accounted for 4.3% of all cases, and infection occurred in 87.1% of all patients during induction therapy. Patients who received HMA and low-dose chemotherapy presented with significantly superior response and long-term survival rates compared to those who received HMA alone. They also showed comparable outcomes to those treated with the azacitidine plus venetoclax protocol. Low-dose chemotherapy in combination with decitabine or azacitidine showed a similar response rate and prognosis. Age ≥ 75years and a white blood cell (WBC) count ≥ 10 × 109 cells/L were identified as independent adverse prognostic factors for OS, while poor-risk cytogenetics, percentage of bone marrow blasts, and s/tAML had no significant impact on OS when patients were treated with HMA-based regimens. In conclusion, HMA combined with low-dose chemotherapy was effective and safe in older adults with AML who were unfit for intensive chemotherapy, and no difference was observed between decitabine and azacitidine.
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Affiliation(s)
| | - Jing Cao
- Fujian Medical University Union Hospital, Fujian Institute of Hematology, Fuzhou, China
| | - Yaozhen Ye
- Fujian Medical University Union Hospital, Fujian Institute of Hematology, Fuzhou, China
| | - Luting Luo
- Fujian Medical University Union Hospital, Fujian Institute of Hematology, Fuzhou, China
| | - Xiaoyun Zheng
- Fujian Medical University Union Hospital, Fujian Institute of Hematology, Fuzhou, China
| | - Xiaozhu Yang
- Fujian Medical University Union Hospital, Fujian Institute of Hematology, Fuzhou, China
| | - Zhihong Zheng
- Fujian Medical University Union Hospital, Fujian Institute of Hematology, Fuzhou, China
| | - Jing Zheng
- Fujian Medical University Union Hospital, Fujian Institute of Hematology, Fuzhou, China
| | - Ting Yang
- Fujian Medical University Union Hospital, Fujian Institute of Hematology, Fuzhou, China
| | - Jianda Hu
- Fujian Medical University Union Hospital, Fujian Institute of Hematology, Fuzhou, China
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Schlosser P, Knaus J, Schmutz M, Dohner K, Plass C, Bullinger L, Claus R, Binder H, Lubbert M, Schumacher M. Netboost: Boosting-Supported Network Analysis Improves High-Dimensional Omics Prediction in Acute Myeloid Leukemia and Huntington's Disease. IEEE/ACM TRANSACTIONS ON COMPUTATIONAL BIOLOGY AND BIOINFORMATICS 2021; 18:2635-2648. [PMID: 32365034 DOI: 10.1109/tcbb.2020.2983010] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
State-of-the art selection methods fail to identify weak but cumulative effects of features found in many high-dimensional omics datasets. Nevertheless, these features play an important role in certain diseases. We present Netboost, a three-step dimension reduction technique. First, a boosting-based filter is combined with the topological overlap measure to identify the essential edges of the network. Second, sparse hierarchical clustering is applied on the selected edges to identify modules and finally module information is aggregated by the first principal components. We demonstrate the application of the newly developed Netboost in combination with CoxBoost for survival prediction of DNA methylation and gene expression data from 180 acute myeloid leukemia (AML) patients and show, based on cross-validated prediction error curve estimates, its prediction superiority over variable selection on the full dataset as well as over an alternative clustering approach. The identified signature related to chromatin modifying enzymes was replicated in an independent dataset, the phase II AMLSG 12-09 study. In a second application we combine Netboost with Random Forest classification and improve the disease classification error in RNA-sequencing data of Huntington's disease mice. Netboost is a freely available Bioconductor R package for dimension reduction and hypothesis generation in high-dimensional omics applications.
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Zee BM, Poels KE, Yao CH, Kawabata KC, Wu G, Duy C, Jacobus WD, Senior E, Endress JE, Jambhekar A, Lovitch SB, Ma J, Dhall A, Harris IS, Blanco MA, Sykes DB, Licht JD, Weinstock DM, Melnick A, Haigis MC, Michor F, Shi Y. Combined epigenetic and metabolic treatments overcome differentiation blockade in acute myeloid leukemia. iScience 2021; 24:102651. [PMID: 34151238 PMCID: PMC8192696 DOI: 10.1016/j.isci.2021.102651] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 12/03/2020] [Accepted: 05/24/2021] [Indexed: 02/07/2023] Open
Abstract
A hallmark of acute myeloid leukemia (AML) is the inability of self-renewing malignant cells to mature into a non-dividing terminally differentiated state. This differentiation block has been linked to dysregulation of multiple cellular processes, including transcriptional, chromatin, and metabolic regulation. The transcription factor HOXA9 and the histone demethylase LSD1 are examples of such regulators that promote differentiation blockade in AML. To identify metabolic targets that interact with LSD1 inhibition to promote myeloid maturation, we screened a small molecule library to identify druggable substrates. We found that differentiation caused by LSD1 inhibition is enhanced by combined perturbation of purine nucleotide salvage and de novo lipogenesis pathways, and identified multiple lines of evidence to support the specificity of these pathways and suggest a potential basis of how perturbation of these pathways may interact synergistically to promote myeloid differentiation. In sum, these findings suggest potential drug combination strategies in the treatment of AML.
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Affiliation(s)
- Barry M. Zee
- Division of Newborn Medicine, Boston Children's Hospital, Boston, MA 02115, USA
- Ludwig Institute for Cancer Research, Oxford University, OX3 7DQ, UK
| | - Kamrine E. Poels
- Department of Data Science, Dana Farber Cancer Institute, Boston, MA 02215, USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Cong-Hui Yao
- Department of Cell Biology, Harvard Medical School, Boston, MA 02115, USA
| | - Kimihito C. Kawabata
- Division of Hematology-Medical Oncology, Weill Cornell Medicine, New York, NY 10065, USA
| | - Gongwei Wu
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Cihangir Duy
- Cancer Signaling and Epigenetics Program, Institute for Cancer Research, Fox Chase Cancer Center, Philadelphia, PA 19111, USA
- Cancer Epigenetics Institute, Fox Chase Cancer Center, Philadelphia, PA 19111, USA
| | - William D. Jacobus
- Division of Newborn Medicine, Boston Children's Hospital, Boston, MA 02115, USA
| | - Elizabeth Senior
- Division of Newborn Medicine, Boston Children's Hospital, Boston, MA 02115, USA
| | | | - Ashwini Jambhekar
- Division of Newborn Medicine, Boston Children's Hospital, Boston, MA 02115, USA
- Department of Systems Biology, Harvard Medical School, Boston, MA 02115, USA
- The Ludwig Center at Harvard, Boston, MA 02115, USA
| | - Scott B. Lovitch
- Department of Pathology, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Jiexian Ma
- Division of Newborn Medicine, Boston Children's Hospital, Boston, MA 02115, USA
| | - Abhinav Dhall
- Division of Newborn Medicine, Boston Children's Hospital, Boston, MA 02115, USA
- Ludwig Institute for Cancer Research, Oxford University, OX3 7DQ, UK
| | - Isaac S. Harris
- Department of Cell Biology, Harvard Medical School, Boston, MA 02115, USA
| | - M. Andres Blanco
- Division of Newborn Medicine, Boston Children's Hospital, Boston, MA 02115, USA
| | - David B. Sykes
- Center for Regenerative Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Jonathan D. Licht
- Division of Hematology and Oncology, University of Florida Health Care Center, Gainesville, FL 32610, USA
| | - David M. Weinstock
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
- Cancer Biology Program, Broad Institute of MIT and Harvard University, Cambridge, MA 02142, USA
| | - Ari Melnick
- Division of Hematology-Medical Oncology, Weill Cornell Medicine, New York, NY 10065, USA
| | - Marcia C. Haigis
- Department of Cell Biology, Harvard Medical School, Boston, MA 02115, USA
| | - Franziska Michor
- Department of Data Science, Dana Farber Cancer Institute, Boston, MA 02215, USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
- The Ludwig Center at Harvard, Boston, MA 02115, USA
- Department of Stem Cell and Regenerative Biology, Harvard University, Cambridge, MA 02138, USA
- The Broad Institute of MIT and Harvard, Cambridge, MA 02139, USA
- The Center for Cancer Evolution, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Yang Shi
- Division of Newborn Medicine, Boston Children's Hospital, Boston, MA 02115, USA
- Ludwig Institute for Cancer Research, Oxford University, OX3 7DQ, UK
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Wang B, Guan W, Lv N, Li T, Yu F, Huang Y, Wang Y, Li L, Yu L. Genetic features and efficacy of decitabine-based chemotherapy in elderly patients with acute myeloid leukemia. HEMATOLOGY (AMSTERDAM, NETHERLANDS) 2021; 26:371-379. [PMID: 33971800 DOI: 10.1080/16078454.2021.1921434] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES The outcome of elderly acute myeloid leukemia (AML) patients is poor, which was traditionally attributed to patient- and leukemia-related factors. However, studies about the genetic features of these elderly patients have not been integrated and the genetic mechanism of their poor outcome is less known. METHODS Here, we used next generation sequencing (NGS) to identify the genetic features of elderly AML patients and confirmed the efficacy of chemotherapy based on molecular aberrations. Mutations in 111 genes relevant to hematological malignancy was analysed by virtue of NGS and the genetic differences were compared between elderly (n=52) and young (n=161) AML patients. Furthermore, the outcome of decitabine-based chemotherapy was identified in elderly patients. RESULTS Frequencies of adverse genetic alterations, such as RUNX1 and secondary-type mutations (ASXL1, STAG2 and spliceosome), were much higher in elderly patients, while the frequency of WT1 mutations was much lower. Moreover, epigenetic mutations such as DNMT3A, TET2, ASXL1 and IDH2, were also more common in elderly patients. Furthermore, there were 39 elderly patients receiving the decitabine-based chemotherapy, and the results showed that the overall response rate (ORR) and complete remission rate (CR) were 76.9% and 71.8%, respectively. The median overall survival (OS) for those older patients was 12 months, and the 2-year OS probability was 20.5%. DISCUSSION Our study provides deep understanding into the molecular mechanisms of the poor outcome of elderly AML patients. CONCLUSION Epigenetic mutations play an important role, and decitabine-based regimen can be used as alternative first-line chemotherapy for elderly patients.
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Affiliation(s)
- Bianhong Wang
- Department of Hematology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, People's Republic of China.,Department of Hematology, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Wei Guan
- Department of Hematology, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Na Lv
- Department of Hematology, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Ting Li
- Annoroad Gene Technology, Beijing, People's Republic of China
| | - Fan Yu
- Department of Hematology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, People's Republic of China
| | - Yuehua Huang
- Department of Hematology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, People's Republic of China
| | - Yanying Wang
- Department of Hematology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, People's Republic of China
| | - Lihong Li
- Department of Hematology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, People's Republic of China
| | - Li Yu
- Department of Hematology, Chinese PLA General Hospital, Beijing, People's Republic of China.,Department of Hematology and Oncology, Shenzhen University General Hospital; Shenzhen University International Cancer Center, Shenzhen University Health Science Center, Shenzhen, People's Republic of China
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Minimally myelosuppressive regimen for remission induction in pediatric AML: long-term results of an observational study. Blood Adv 2021; 5:1837-1847. [PMID: 33787864 DOI: 10.1182/bloodadvances.2020003453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 02/16/2021] [Indexed: 11/20/2022] Open
Abstract
Treatment refusal and death as a result of toxicity account for most treatment failures among children with acute myeloid leukemia (AML) in resource-constrained settings. We recently reported the results of treating children with AML with a combination of low-dose cytarabine and mitoxantrone or omacetaxine mepesuccinate with concurrent granulocyte colony-stimulating factor (G-CSF) (low-dose chemotherapy [LDC]) for remission induction followed by standard postremission strategies. We have now expanded the initial cohort and have provided long-term follow-up. Eighty-three patients with AML were treated with the LDC regimen. During the study period, another 100 children with AML received a standard-dose chemotherapy (SDC) regimen. Complete remission was attained in 88.8% and 86.4% of patients after induction in the LDC and SDC groups, respectively (P = .436). Twenty-two patients in the LDC group received SDC for the second induction course. Significantly more high-risk AML patients were treated with the SDC regimen (P = .035). There were no significant differences between the LDC and SDC groups in 5-year event-free survival (61.4% ± 8.7% vs 65.2% ± 7.4%, respectively; P = .462), overall survival (72.7% ± 6.9% vs 72.5% ± 6.2%, respectively; P = .933), and incidence of relapse (20.5% ± 4.5% vs 17.6% ± 3.9%, respectively; P = .484). Clearance of mutations based on the average variant allele frequency at complete remission in the LDC and SDC groups was 1.9% vs 0.6% (P < .001) after induction I and 0.17% vs 0.078% (P = .052) after induction II. In conclusion, our study corroborated the high remission rate reported for children with AML who received at least 1 course of LDC. The results, although preliminary, also suggest that long-term survival of these children is comparable to that of children who receive SDC regimens.
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An Opportunity for Hospice Referral in Acute Myeloid Leukemia: Prognostic Significance of Hospitalization Status at Time of Second Cycle of Hypomethylating Agents for Patients Ineligible for Intensive Induction Chemotherapy. J Palliat Med 2020; 23:1424-1425. [DOI: 10.1089/jpm.2020.0355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Meillon-Garcia LA, Demichelis-Gómez R. Access to Therapy for Acute Myeloid Leukemia in the Developing World: Barriers and Solutions. Curr Oncol Rep 2020; 22:125. [PMID: 33025161 PMCID: PMC7538168 DOI: 10.1007/s11912-020-00987-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW Acute myeloid leukemia (AML) is a costly disease, and its impact is greater in developing countries (DC). We will review the current concept of what are DC, compare the differences in the epidemiology and economic burden of this disease between developed and DC, and finally, analyze the barriers and possible solutions that DC should implement to achieve better results. RECENT FINDINGS DC is a frequently misunderstood name. The way we use to measure human development is changing, and multidimension metrics better define what are DC. With this in mind, we show the differences in the AML epidemiology and the impact of economic burden in DC. We analyze the barriers to access therapy from a clinician point of view, to show that most DC shared similar challenges but with a diverse healthcare structure. Finally, we provide several possible solutions for a more integrated and timely treatment that allows better results not only in terms of survival but with a better quality of life. The economic burden of AML treatment in DC is high, and the results are poor. It is crucial to face this challenge and propose new treatment approaches to achieve better results.
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Affiliation(s)
| | - Roberta Demichelis-Gómez
- Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Subirán, SSA, Ciudad De Mexico, Mexico
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10
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Bazarbachi A, Schmid C, Labopin M, Beelen D, Wolfgang Blau I, Potter V, Niittyvuopio R, Socié G, Blaise D, Sanz J, Ciceri F, Abou Dalle I, Spyridonidis A, Bug G, Esteve J, Savani BN, Nagler A, Mohty M. Evaluation of Trends and Prognosis Over Time in Patients with AML Relapsing After Allogeneic Hematopoietic Cell Transplant Reveals Improved Survival for Young Patients in Recent Years. Clin Cancer Res 2020; 26:6475-6482. [PMID: 32988970 DOI: 10.1158/1078-0432.ccr-20-3134] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 09/10/2020] [Accepted: 09/22/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE Relapsed acute myeloid leukemia (AML) post allogeneic hematopoietic cell transplantation (allo-HCT) has a dismal prognosis. EXPERIMENTAL DESIGN To assess prognosis of patients with recurrent AML post allo-HCT over time, we analyzed European Society for Blood and Marrow Transplantation registry data of 8,162 adult patients with AML who relapsed between 2000 and 2018 after allo-HCT performed in first complete remission from matched sibling, unrelated, or haploidentical donors. RESULTS The 2-year overall survival (OS) rate from relapse was 17%. For 3,630 patients, <50 years of age, the 2-year OS continuously increased from 16% between 2000 and 2004 to 18% for 2005-2009, to 21% for 2010-2014, and to 26% for 2015-2018 (P = 0.001). Improvement over time was noted both after relapse within and beyond 6 months from allo-HCT. On multivariate analysis among patients <50 years of age, OS was positively affected by a later year of relapse (baseline: 2000-2004; HR, 0.82; P < 0.02 for 2010-2014 and HR, 0.72; P = 0.0002 for 2015-2018), good performance status, favorable cytogenetics, and longer time from transplant to relapse, but negatively affected by increasing age. In contrast, among 4,532 patients, >50 years of age, the year of relapse had no influence on OS (16% for 2000-2004 and 14% for 2015-2018; P = 0.56). Regarding treatment, encouraging results were observed after second allo-HCT, which was performed within 2 years after relapse in 17% of the entire cohort, resulting in a 2-year OS of 30.7%. CONCLUSIONS Outcome after posttransplant relapse among younger patients has improved significantly in recent years, likely reflecting, among other factors, the efficacy of posttransplant salvage including second allo-HCT.
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Affiliation(s)
- Ali Bazarbachi
- Bone marrow Transplant Program, Department of Internal Medicine, American University of Beirut, Beirut, Lebanon.
| | - Christoph Schmid
- Department of Haematology and Oncology, Augsburg University Hospital and Medical Faculty, Augsburg, Germany.
| | - Myriam Labopin
- Department of Haematology and EBMT Paris Study Office/CEREST-TC, Saint Antoine Hospital, Paris, France
| | - Dietrich Beelen
- Department of Bone Marrow Transplantation, University Hospital, Essen, Germany
| | - Igor Wolfgang Blau
- Medizinische Klinik m. S. Hämatologie, Onkologie und Tumorimmunologie, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Victoria Potter
- Department of Haematological Medicine, GKT School of Medicine, London, United Kingdom
| | - Riitta Niittyvuopio
- HUCH Comprehensive Cancer Center, Stem Cell Transplantation Unit, Helsinki, Finland
| | - Gerard Socié
- Programme de Transplantation & Thérapie Cellulaire, Centre de Recherche en Cancérologie de Marseille, Institut Paoli Calmettes, Marseille, France
| | - Didier Blaise
- Programme de Transplantation & Thérapie Cellulaire, Centre de Recherche en Cancérologie de Marseille, Institut Paoli Calmettes, Marseille, France
| | - Jaime Sanz
- Department of Hematology (Torre F, Planta 7), University Hospital La Fe, Valencia, Spain
| | - Fabio Ciceri
- Ospedale San Raffaele s.r.l., Haematology and BMT, Milano, Italy
| | - Iman Abou Dalle
- Bone marrow Transplant Program, Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | | | - Gesine Bug
- Goethe-Universitaet, Medizinische Klinik II, Hämatologie, Medizinische Onkologie, Frankfurt Main, Germany
| | - Jordi Esteve
- Department of Hematology, Hospital Clinic, Institute of Hematology & Oncology, Barcelona, Spain
| | - Bipin N Savani
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Arnon Nagler
- Department of Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel HaShomer, Ramat Gan, Israel
| | - Mohamad Mohty
- Department of Clinical Hematology and Cellular Therapy, Saint-Antoine Hospital, INSERM UMR 938 and Sorbonne University, Paris, France
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Fan T, Quan RC, Liu WY, Xiao HY, Tang XD, Liu C, Li L, Lv Y, Wang HZ, Xu YG, Guo XQ, Hu XM. Arsenic-Containing Qinghuang Powder () is an Alternative Treatment for Elderly Acute Myeloid Leukemia Patients Refusing Low-Intensity Chemotherapy. Chin J Integr Med 2019; 26:339-344. [PMID: 31848890 DOI: 10.1007/s11655-019-3050-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To analyze the overall survival (OS) of elderly acute myeloid leukemia (AML) patients treated with oral arsenic-containing Qinghuang Powder (, QHP) or low-intensity chemotherapy (LIC). METHODS Forty-two elderly AML patients treated with intravenous or subcutaneous LIC (1 month for each course, at least 3 courses) or oral QHP (3 months for each course, at least 2 courses) were retrospectively analyzed from January 2015 to December 2017. The main endpoints of analysis were OS and 1-, 2-, 3-year OS rates of patients, respectively. And the adverse reactions induding bone marrow suppression, digestive tract discomfort and myocardia injury were observed. RESULTS Out of 42 elderly AML patients, 22 received LIC treatment and 20 received QHP treatment, according to patients' preference. There was no significant difference on OS between LIC and QHP patients (13.0 months vs. 13.5 months, >0.05). There was no significant difference on OS rates between LIC and QHP groups at 1 year (59.1% vs. 70.0%), 2 years (13.6% vs. 15%), and 3 years (4.6% vs. 5.0%, all >0.05). Furthermore, there was no significant difference of OS on prognosis stratification of performance status > 2 (12 months vs. 12 months), age> 75 year-old (12.0 months vs. 12.5 months), hematopoietic stem cell transplant comorbidity index >2 (12 months vs. 13 months), poor cytogenetics (12 months vs. 8 months), and diagnosis of secondary AML (10 months vs. 14 months) between LIC and QHP patients (>0.05). CONCLUSION QHP may be an alternative treatment for elderly AML patients refusing LIC therapy.
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Affiliation(s)
- Teng Fan
- Department of Hematology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China
- Graduate School, China Academy of Chinese Medical Sciences, Beijing, 100700, China
| | - Ri-Cheng Quan
- Department of Hematology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China
| | - Wei-Yi Liu
- Department of Hematology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China
| | - Hai-Yan Xiao
- Department of Hematology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China
| | - Xu-Dong Tang
- Department of Hematology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China
| | - Chi Liu
- Department of Hematology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China
| | - Liu Li
- Department of Hematology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China
| | - Yan Lv
- Department of Hematology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China
| | - Hong-Zhi Wang
- Department of Hematology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China
| | - Yong-Gang Xu
- Department of Hematology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China
| | - Xiao-Qing Guo
- Department of Hematology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China
| | - Xiao-Mei Hu
- Department of Hematology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China.
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12
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Shargian-Alon L, Gurion R, Raanani P, Yahav D, Gafter-Gvili A. Hypomethylating Agents-associated Infections—Systematic Review and Meta-analysis of Randomized Controlled Trials. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2018; 18:603-610.e1. [DOI: 10.1016/j.clml.2018.05.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 05/12/2018] [Accepted: 05/21/2018] [Indexed: 01/24/2023]
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13
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Krok‐Schoen JL, Fisher JL, Stephens JA, Mims A, Ayyappan S, Woyach JA, Rosko AE. Incidence and survival of hematological cancers among adults ages ≥75 years. Cancer Med 2018; 7:3425-3433. [PMID: 29654631 PMCID: PMC6051144 DOI: 10.1002/cam4.1461] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 02/16/2018] [Accepted: 02/28/2018] [Indexed: 11/07/2022] Open
Abstract
Evaluating population-based data of hematologic malignancies (HMs) in older adults provides prognostic information for this growing demographic. Incidence rates and one- and five-year relative survival rates were examined for specific HMs among adults ages ≥75 years using data from the Surveillance, Epidemiology and End Results (SEER) Program. Hematologic malignancy cases (Hodgkin lymphoma (HL), non-Hodgkin lymphoma (NHL), multiple myeloma (MM), acute lymphocytic leukemia (ALL), chronic lymphocytic leukemia (CLL), acute myeloid leukemia (AML), and chronic myeloid leukemia (CML)) were reported to one of 18 SEER registries. Recent average annual (2010-2014) incidence rates and incidence trends from 1973 to 2014 were examined for cases ages ≥75 years. One- and five-year relative cancer survival rates were examined for adults ages ≥75 years diagnosed 2007-2013, with follow-up into 2014. From 1973 to 2014, incidence rates increased for NHL, MM, and AML, decreased for HL, and remained relatively stable for ALL, CLL, and CML among adults ages ≥75 years. The highest one- and five-year relative survival rates were observed among adults with CLL ages 75-84 years (1 year: 91.8% (95% CI = 91.8-90.8)) and 5 years: 76.5% (95% CI = 74.2-78.6)). The lowest one- and five-year survival rates were observed among adults with AML ages 75-84 (1 year: 18.2% (95% CI = 74.2-78.6) and 5 years: 2.7% (95% CI = 2.0-3.6)). Survival for older adults ages ≥75 years with HMs is poor, particularly for acute leukemia. Understanding the heterogeneity in HM outcomes among older patients may help clinicians better address the hematological cancer burden and mortality in the aging population.
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Affiliation(s)
- Jessica L. Krok‐Schoen
- Division of Medical Dietetics and Health SciencesSchool of Health and Rehabilitation SciencesCollege of MedicineThe Ohio State UniversityColumbusOhio
- Comprehensive Cancer CenterThe Ohio State UniversityColumbusOhio
| | - James L. Fisher
- Arthur G. James Cancer Hospital and Richard J. Solove Research InstituteColumbusOhio
| | | | - Alice Mims
- Arthur G. James Cancer Hospital and Richard J. Solove Research InstituteColumbusOhio
- Division of HematologyDepartment of Internal MedicineCollege of MedicineThe Ohio State UniversityColumbusOhio
| | - Sabarish Ayyappan
- Arthur G. James Cancer Hospital and Richard J. Solove Research InstituteColumbusOhio
- Division of HematologyDepartment of Internal MedicineCollege of MedicineThe Ohio State UniversityColumbusOhio
| | - Jennifer A. Woyach
- Arthur G. James Cancer Hospital and Richard J. Solove Research InstituteColumbusOhio
- Division of HematologyDepartment of Internal MedicineCollege of MedicineThe Ohio State UniversityColumbusOhio
| | - Ashley E. Rosko
- Arthur G. James Cancer Hospital and Richard J. Solove Research InstituteColumbusOhio
- Division of HematologyDepartment of Internal MedicineCollege of MedicineThe Ohio State UniversityColumbusOhio
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14
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Stein EM, Bonifacio G, Latremouille-Viau D, Guerin A, Shi S, Gagnon-Sanschagrin P, Briggs O, Joseph GJ. Treatment patterns, healthcare resource utilization, and costs in patients with acute myeloid leukemia in commercially insured and Medicare populations. J Med Econ 2018; 21:556-563. [PMID: 29304724 DOI: 10.1080/13696998.2018.1425209] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To describe the setting, duration, and costs of induction and consolidation chemotherapy for adults with newly-diagnosed acute myeloid leukemia (AML), who are candidates for standard induction chemotherapy, in the US. METHODS Adults newly-diagnosed with AML who received standard induction chemotherapy in an inpatient setting were identified from the Truven Health Analytics MarketScan (2006-2015) and SEER-Medicare (2007-2011) databases. Patients were observed from induction therapy start to the first of hematopoietic stem cell transplant, 180 days after induction discharge, health plan enrollment/data availability end, or death. Induction and consolidation chemotherapy were identified using Diagnosis-Related Group codes (chemotherapy with acute leukemia) or procedure codes for AML chemotherapy administration. AML treatment episode setting (inpatient or outpatient), duration, and costs (2015 USD, payers' perspective) were described for commercially insured patients and Medicare beneficiaries. RESULTS In total, 459 commercially insured patients and 563 Medicare beneficiaries (mean age = 54 and 66 years; 53% and 54% male; respectively) were identified. For induction therapy, mean costs were $145,189 for commercially insured patients and $85,734 for Medicare beneficiaries, and median inpatient duration was 31 days (both). Following induction, 64% of commercially insured patients and 53% of Medicare beneficiaries had ≥1 consolidation cycle; 75% and 65% of consolidation cycles were in an inpatient setting, respectively. For consolidation cycles, in the inpatient setting, mean costs were $28,137 for commercially insured patients and $28,843 for Medicare beneficiaries, median cycle duration was 6 days (both); in the outpatient setting, mean costs were $11,271 for commercially insured patients and $5,803 Medicare beneficiaries, median duration was 5 days (both). LIMITATIONS Granular information on chemotherapy type administered was unavailable. CONCLUSIONS This is the first exploratory study providing a complete picture of recent AML treatment patterns and management costs among commercially insured patients and Medicare beneficiaries. There is substantial heterogeneity in the management and costs of AML.
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Affiliation(s)
- Eytan M Stein
- a Memorial Sloan Kettering Cancer Center , New York , NY , USA
| | | | | | - Annie Guerin
- c Analysis Group, Inc. , Montreal , Quebec , Canada
| | - Sherry Shi
- c Analysis Group, Inc. , Montreal , Quebec , Canada
| | | | - Owanate Briggs
- b Novartis Pharmaceuticals Corporation , East Hanover , NJ , USA
| | - George J Joseph
- b Novartis Pharmaceuticals Corporation , East Hanover , NJ , USA
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15
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Bairey O, Siegal T. The possible role of maintenance treatment for primary central nervous system lymphoma. Blood Rev 2018; 32:378-386. [PMID: 29551465 DOI: 10.1016/j.blre.2018.03.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 02/27/2018] [Accepted: 03/09/2018] [Indexed: 12/22/2022]
Abstract
Primary central nervous system lymphoma (PCNSL) is a rare and aggressive brain tumor. The prognosis is poor, with high rates of relapse and disease progression after treatment. In addition, PCNSL affects a largely older population, so that a significant proportion of patients are ineligible for intensive therapies and high-dose chemotherapy. The elderly patients are also susceptible to the accelerated and detrimental cognitive side effects of whole-brain irradiation which is an alternative consolidation to high-dose chemotherapy. Maintenance therapy has been shown to be a promising strategy to prolong remission time in other hematopoietic malignancies. Herein, we discuss the place of maintenance treatment in PCNSL in view of perspective obtained from hematological malignancies and non-Hodgkin's lymphoma.
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Affiliation(s)
- Osnat Bairey
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Tali Siegal
- Neuro-Oncology Center, Davidoff Cancer Center, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel.
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16
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Emadi A, Law JY, Strovel ET, Lapidus RG, Jeng LJB, Lee M, Blitzer MG, Carter-Cooper BA, Sewell D, Van Der Merwe I, Philip S, Imran M, Yu SL, Li H, Amrein PC, Duong VH, Sausville EA, Baer MR, Fathi AT, Singh Z, Bentzen SM. Asparaginase Erwinia chrysanthemi effectively depletes plasma glutamine in adult patients with relapsed/refractory acute myeloid leukemia. Cancer Chemother Pharmacol 2017; 81:217-222. [PMID: 29119293 DOI: 10.1007/s00280-017-3459-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 10/13/2017] [Indexed: 12/30/2022]
Abstract
Depletion of glutamine (Gln) has emerged as a potential therapeutic approach in the treatment of acute myeloid leukemia (AML), as neoplastic cells require Gln for synthesis of cellular components essential for survival. Asparaginases deplete Gln, and asparaginase derived from Erwinia chrysanthemi (Erwinaze) appears to have the greatest glutaminase activity of the available asparaginases. In this Phase I study, we sought to determine the dose of Erwinaze that safely and effectively depletes plasma Gln levels to ≤ 120 μmol/L in patients with relapsed or refractory (R/R) AML. Five patients were enrolled before the study was halted due to issues with Erwinaze manufacturing supply. All patients received Erwinaze at a dose of 25,000 IU/m2 intravenously three times weekly for 2 weeks. Median trough plasma Gln level at 48 h after initial Erwinaze administration was 27.6 μmol/L, and 80% (lower limit of 1-sided 95% CI 34%) of patients achieved at least one undetectable plasma Gln value (< 12.5 μmol/L), with the fold reduction (FR) in Gln level at 3 days, relative to baseline, being 0.16 (p < 0.001 for rejecting FR = 1). No dose-limiting toxicities were identified. Two patients responded, one achieved partial remission and one achieved hematologic improvement after six doses of Erwinaze monotherapy. These data suggest asparaginase-induced Gln depletion may have an important role in the management of patients with AML, and support more pharmacologic and clinical studies on the mechanistically designed asparaginase combinations in AML.
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Affiliation(s)
- Ashkan Emadi
- University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, USA. .,Department of Medicine, University of Maryland, Baltimore, USA. .,Department of Pharmacology, University of Maryland, Baltimore, USA.
| | - Jennie Y Law
- University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, USA.,Department of Medicine, University of Maryland, Baltimore, USA
| | - Erin T Strovel
- Department of Pediatrics, University of Maryland, Baltimore, USA
| | - Rena G Lapidus
- University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, USA.,Department of Medicine, University of Maryland, Baltimore, USA
| | - Linda J B Jeng
- Department of Medicine, University of Maryland, Baltimore, USA.,Department of Pediatrics, University of Maryland, Baltimore, USA.,Department of Pathology, University of Maryland, Baltimore, USA
| | - Myounghee Lee
- University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, USA
| | - Miriam G Blitzer
- Department of Pediatrics, University of Maryland, Baltimore, USA
| | | | - Danielle Sewell
- Department of Medicine, University of Maryland, Baltimore, USA
| | | | - Sunita Philip
- University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, USA
| | - Mohammad Imran
- University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, USA
| | - Stephen L Yu
- University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, USA
| | - Hongxia Li
- University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, USA
| | - Philip C Amrein
- Massachusetts General Hospital Harvard Medical School, Boston, USA
| | - Vu H Duong
- University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, USA.,Department of Medicine, University of Maryland, Baltimore, USA
| | - Edward A Sausville
- University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, USA.,Department of Medicine, University of Maryland, Baltimore, USA.,Department of Pharmacology, University of Maryland, Baltimore, USA
| | - Maria R Baer
- University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, USA.,Department of Medicine, University of Maryland, Baltimore, USA
| | - Amir T Fathi
- Massachusetts General Hospital Harvard Medical School, Boston, USA
| | - Zeba Singh
- Department of Pathology, University of Maryland, Baltimore, USA
| | - Søren M Bentzen
- University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, USA.,Epidemiology and Public Health, University of Maryland, Baltimore, USA
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17
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Abstract
INTRODUCTION Treatment of elderly patients with acute leukemia is challenging. Older age is associated with increased risk of treatment-related toxicity. Currently, no consensus exists regarding optimal therapy in this patient population. Areas covered: The following review is a comprehensive summary of various therapeutic options reported over the past few years in elderly patients with acute leukemia. Expert commentary: While evidences can guide identification of frail older patients, sensitive assessment strategies are required to identify fit and vulnerable patients regardless of chronologic age. Individualized treatments may take into account not only an increase in survival, but also the maintenance or improvement in terms of quality of life, the management of symptoms, and a maximization of time outside of hospital care. In this setting, comprehensive geriatric assessments have been shown to improve routine assessment. Molecular abnormalities provide the genomic footprint for the development of targeted therapies. The addition of new monoclonal antibodies to conventional treatments also demonstrated promising primary results. Ongoing clinical trials testing the activity of these new agents may reshape treatment strategies in the elderly patient population.
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Affiliation(s)
- Xavier Thomas
- a Hospices Civils de Lyon, Hematology Department , Lyon-Sud Hospital , Pierre Bénite , France
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18
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Therapeutic decision-making in elderly patients with acute myeloid leukemia: conventional intensive chemotherapy versus hypomethylating agent therapy. Ann Hematol 2017; 96:1801-1809. [DOI: 10.1007/s00277-017-3104-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 08/10/2017] [Indexed: 01/23/2023]
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