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Rossi G, Borlenghi E, Zappasodi P, Lussana F, Bernardi M, Basilico C, Molteni A, Lotesoriere I, Turrini M, Frigeni M, Fumagalli M, Cozzi P, Gigli F, Cattaneo C, Fracchiolla NS, Riva M, Martini G, Mancini V, Cairoli R, Todisco E. Adapting the Fitness Criteria for Non-Intensive Treatments in Older Patients with Acute Myeloid Leukemia to the Use of Venetoclax-Hypomethylating Agents Combination-Practical Considerations from the Real-Life Experience of the Hematologists of the Rete Ematologica Lombarda. Cancers (Basel) 2024; 16:386. [PMID: 38254875 PMCID: PMC10814062 DOI: 10.3390/cancers16020386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 01/08/2024] [Accepted: 01/12/2024] [Indexed: 01/24/2024] Open
Abstract
A retrospective survey was conducted in hematologic centres of the Rete Ematologica Lombarda (REL) on 529 older AML patients seen between 2020-2022. Compared to 2008-2016, the use of intensive chemotherapy (ICT) decreased from 40% to 18.1% and of hypomethylating agents (HMAs) from 19.5% to 13%, whereas the combination of Venetoclax/HMA, initially not available, increased from 0% to 36.7%. Objective treatment-specific fitness criteria proposed by SIE/SIES/GITMO in 2013 allow an appropriate choice between ICT and HMAs by balancing their efficacy and toxicity. Venetoclax/HMA, registered for patients unfit to ICT, has a unique toxicity profile because of prolonged granulocytopenia and increased infectious risk. Aiming at defining specific fitness criteria for the safe use of Venetoclax/HMA, a preliminary investigation was conducted among expert REL hematologists, asking for modifications of SIE/SIES/GITMO criteria they used to select candidates for Venetoclax/HMA. While opinions among experts varied, a general consensus emerged on restricting SIE/SIES/GITMO criteria for ICT-unfit patients to an age limit of 80-85, cardiac function > 40%, and absence of recurrent lung infections, bronchiectasis, or exacerbating COPD. Also, the presence of an adequate caregiver was considered mandatory. Such expert opinions may be clinically useful and may be considered when treatment-specific fitness criteria are updated to include Venetoclax/HMA.
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Affiliation(s)
- Giuseppe Rossi
- Department of Hematology, ASST Spedali Civili of Brescia, 25100 Brescia, Italy; (E.B.); (C.C.)
| | - Erika Borlenghi
- Department of Hematology, ASST Spedali Civili of Brescia, 25100 Brescia, Italy; (E.B.); (C.C.)
| | - Patrizia Zappasodi
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, 27100 Pavia, Italy; (P.Z.); (G.M.)
| | - Federico Lussana
- Department of Oncology and Hematology, University of Milan and Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, 24100 Bergamo, Italy; (F.L.); (M.F.)
| | - Massimo Bernardi
- Haematology and Bone Marrow Transplantation Unit, San Raffaele Scientific Institute, 20132 Milano, Italy;
| | - Claudia Basilico
- Division of Hematology, ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi, 21100 Varese, Italy;
| | - Alfredo Molteni
- Department of Hematology, ASST di Cremona, 26100 Cremona, Italy;
| | - Ivana Lotesoriere
- Department of Hematology, Ospedale Busto Arsizio, ASST Valle Olona, 21052 Busto Arsizio, Italy;
| | - Mauro Turrini
- Division of Hematology, Ospedale Valduce, 22100 Como, Italy; (M.T.); (E.T.)
| | - Marco Frigeni
- Department of Oncology and Hematology, University of Milan and Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, 24100 Bergamo, Italy; (F.L.); (M.F.)
| | - Monica Fumagalli
- Department of Hematology, Ospedale “San Gerardo” ASST di Monza, 20900 Monza, Italy;
| | - Paola Cozzi
- Unità Complessa di Ematologia, ASST Ovest Milanese, Ospedale Civile, 20025 Legnano, Italy;
| | - Federica Gigli
- Divisione di Emato-Oncologia, European Institute of Oncology, 20122 Milano, Italy;
| | - Chiara Cattaneo
- Department of Hematology, ASST Spedali Civili of Brescia, 25100 Brescia, Italy; (E.B.); (C.C.)
| | - Nicola Stefano Fracchiolla
- UOC Oncoematologia, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico and University of Milan, 20122 Milano, Italy;
| | - Marta Riva
- Dipartimento di Ematologia ed Oncologia, Niguarda Cancer Center ASST Grande Ospedale Metropolitano, 20162 Milano, Italy; (M.R.); (V.M.); (R.C.)
| | - Gianluca Martini
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, 27100 Pavia, Italy; (P.Z.); (G.M.)
| | - Valentina Mancini
- Dipartimento di Ematologia ed Oncologia, Niguarda Cancer Center ASST Grande Ospedale Metropolitano, 20162 Milano, Italy; (M.R.); (V.M.); (R.C.)
| | - Roberto Cairoli
- Dipartimento di Ematologia ed Oncologia, Niguarda Cancer Center ASST Grande Ospedale Metropolitano, 20162 Milano, Italy; (M.R.); (V.M.); (R.C.)
| | - Elisabetta Todisco
- Division of Hematology, Ospedale Valduce, 22100 Como, Italy; (M.T.); (E.T.)
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