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Gaál L, Ruff E, Wiedemann Á, Svorenj S, Szita VR, Tóth AD, Masszi A, Horváth L, Szombath G, Nagy Z, Várkonyi J, Benedek S, Farkas P, Bödör C, Masszi T, Varga G. [How did the survival of acute myeloid leukemia change over the last ten years in our unit?]. Orv Hetil 2023; 164:1787-1794. [PMID: 37952177 DOI: 10.1556/650.2023.32901] [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] [Received: 07/27/2023] [Accepted: 09/03/2023] [Indexed: 11/14/2023]
Abstract
INTRODUCTION Acute myeloid leukemia (AML) is a hematological malignancy with high mortality rate. The treatment is especially challenging in patients older than 65 years, which is the large majority of those. For patients unfit for intensive chemotherapy regimens, only palliative cytoreduction and basic supportive care used to be the options in our unit. However, from 2018, the azacitidine-venetoclax combination has been a new therapeutic alternative. This treatment resulted in marked survival benefit in clinical trials, however, its impact on the daily clinical practice and the entire patient population is unclear. OBJECTIVE Our goal was to evaluate how the application of azacitidine-venetoclax changed the treatment and survival of AML patients in our practice. METHOD We retrospectively analyzed the available clinical data of all AML patients treated consecutively between January 1, 2011 and December 31, 2021 at the 3rd Department of Internal Medicine (from 2020 onward called Department of Internal Medicine and Hematology), examining their treatment depending on the time period of therapy (2011-2017 and 2018-2021). Patients with acute promyelocytic leukemia were excluded. RESULTS 423 patients were diagnosed during this period. The number of cases showed a marked increase: in the first 7 years of our study, 184 patients were diagnosed, while this rose to 239 during the subsequent 4 years. The median age of patients was 67.6 years, with more than 60% of patients aged over 65. An improving trend can be observed in the overall survival: between 2011 and 2017, the median overall survival was 4.8 ± 0.9 months, while between 2018 and 2021, it was 8.3 ± 1.4 months (p = 0.051). Moreover, in the case of patients over 65 there was a significant overall survival improvement: 3.1 ± 0.5 vs. 4.9 ± 0.6 months (p = 0,01). The main factor behind this improvement could be that a large proportion of over 65 patients previously only fit for supportive care could now be treated with azacitidine-venetoclax: the percentage of actively treated patients grew from 57.1% to 75.3% in the second period. CONCLUSION The survival of patients unfit for curative therapy and older than 65 showed a steady increase which can be attributed to the introduction of new therapeutic alternatives. Orv Hetil. 2023; 164(45): 1787-1794.
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Affiliation(s)
- Lilla Gaál
- 1 Semmelweis Egyetem, Általános Orvostudományi Kar Budapest Magyarország
| | - Eszter Ruff
- 1 Semmelweis Egyetem, Általános Orvostudományi Kar Budapest Magyarország
| | - Ádám Wiedemann
- 2 Semmelweis Egyetem, Általános Orvostudományi Kar, Belgyógyászati és Hematológiai Klinika Budapest, Szentkirályi u. 46., 1088 Magyarország
| | - Szabolcs Svorenj
- 2 Semmelweis Egyetem, Általános Orvostudományi Kar, Belgyógyászati és Hematológiai Klinika Budapest, Szentkirályi u. 46., 1088 Magyarország
| | - Virág Réka Szita
- 2 Semmelweis Egyetem, Általános Orvostudományi Kar, Belgyógyászati és Hematológiai Klinika Budapest, Szentkirályi u. 46., 1088 Magyarország
| | - András Dávid Tóth
- 2 Semmelweis Egyetem, Általános Orvostudományi Kar, Belgyógyászati és Hematológiai Klinika Budapest, Szentkirályi u. 46., 1088 Magyarország
| | - András Masszi
- 2 Semmelweis Egyetem, Általános Orvostudományi Kar, Belgyógyászati és Hematológiai Klinika Budapest, Szentkirályi u. 46., 1088 Magyarország
| | - Laura Horváth
- 2 Semmelweis Egyetem, Általános Orvostudományi Kar, Belgyógyászati és Hematológiai Klinika Budapest, Szentkirályi u. 46., 1088 Magyarország
| | - Gergely Szombath
- 2 Semmelweis Egyetem, Általános Orvostudományi Kar, Belgyógyászati és Hematológiai Klinika Budapest, Szentkirályi u. 46., 1088 Magyarország
| | - Zsolt Nagy
- 2 Semmelweis Egyetem, Általános Orvostudományi Kar, Belgyógyászati és Hematológiai Klinika Budapest, Szentkirályi u. 46., 1088 Magyarország
| | - Judit Várkonyi
- 2 Semmelweis Egyetem, Általános Orvostudományi Kar, Belgyógyászati és Hematológiai Klinika Budapest, Szentkirályi u. 46., 1088 Magyarország
| | - Szabolcs Benedek
- 2 Semmelweis Egyetem, Általános Orvostudományi Kar, Belgyógyászati és Hematológiai Klinika Budapest, Szentkirályi u. 46., 1088 Magyarország
| | - Péter Farkas
- 2 Semmelweis Egyetem, Általános Orvostudományi Kar, Belgyógyászati és Hematológiai Klinika Budapest, Szentkirályi u. 46., 1088 Magyarország
| | - Csaba Bödör
- 3 Semmelweis Egyetem, Általános Orvostudományi Kar, Patológiai és Kísérleti Rákkutató Intézet Budapest Magyarország
| | - Tamás Masszi
- 2 Semmelweis Egyetem, Általános Orvostudományi Kar, Belgyógyászati és Hematológiai Klinika Budapest, Szentkirályi u. 46., 1088 Magyarország
| | - Gergely Varga
- 2 Semmelweis Egyetem, Általános Orvostudományi Kar, Belgyógyászati és Hematológiai Klinika Budapest, Szentkirályi u. 46., 1088 Magyarország
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Blakemore C, Damodharan S, Puccetti D. Inv(3) Acute Myeloid Leukemia in a Young Adult and Review of the Literature. Case Rep Oncol Med 2023; 2023:6628492. [PMID: 38026762 PMCID: PMC10657244 DOI: 10.1155/2023/6628492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 10/26/2023] [Indexed: 12/01/2023] Open
Abstract
Acute myeloid leukemia (AML) with the high-risk variant inv(3)/t(3;3) or t(3;3)(q21;26.2) is rarely seen in the pediatric and young adult population. It is associated with poor outcomes with ineffective therapeutic options. Here, we present a case of an 18-year-old female with treatment refractory inv(3) AML in whom remission was unable to be obtained. Better treatment options are needed given the increased resistance to traditional therapy this subtype portrays. Here, we review the literature on pediatric and young adult inv(3) AML along with newer therapeutic options.
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Affiliation(s)
- Carlee Blakemore
- Department of Pediatrics, University of Wisconsin School of Medicine & Public Health, Madison, WI, USA
| | - Sudarshawn Damodharan
- Department of Pediatrics, University of Wisconsin School of Medicine & Public Health, Madison, WI, USA
- Division of Pediatric Hematology, Oncology and Bone Marrow Transplant, University of Wisconsin School of Medicine & Public Health, Madison, WI, USA
| | - Diane Puccetti
- Department of Pediatrics, University of Wisconsin School of Medicine & Public Health, Madison, WI, USA
- Division of Pediatric Hematology, Oncology and Bone Marrow Transplant, University of Wisconsin School of Medicine & Public Health, Madison, WI, USA
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Todisco E, Papayannidis C, Fracchiolla N, Petracci E, Zingaretti C, Vetro C, Martelli MP, Zappasodi P, Di Renzo N, Gallo S, Audisio E, Griguolo D, Cerchione C, Selleri C, Mattei D, Bernardi M, Fumagalli M, Rizzuto G, Facchini L, Basilico CM, Manfra I, Borlenghi E, Cairoli R, Salutari P, Gottardi M, Molteni A, Martini V, Lunghi M, Fianchi L, Cilloni D, Lanza F, Abruzzese E, Cascavilla N, Rivellini F, Ferrara F, Maurillo L, Nanni J, Romano A, Cardinali V, Gigli F, Roncoroni E, Federico V, Marconi G, Volpi R, Sciumè M, Tarella C, Rossi G, Martinelli G. AVALON: The Italian cohort study on real-life efficacy of hypomethylating agents plus venetoclax in newly diagnosed or relapsed/refractory patients with acute myeloid leukemia. Cancer 2023; 129:992-1004. [PMID: 36692409 DOI: 10.1002/cncr.34608] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 10/21/2022] [Accepted: 10/29/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Venetoclax in combination with hypomethylating agents (HMA) is revolutionizing the therapy of acute myeloid leukemia (AML). However, evidence on large sets of patients is lacking, especially in relapsed or refractory leukemia. METHODS AVALON is a multicentric cohort study that was conducted in Italy on patients with AML who received venetoclax-based therapies from 2015 to 2020. The study was approved by the ethics committee of the participating institution and was conducted in accordance with the Declaration of Helsinki. The effectiveness and toxicity of venetoclax + HMA in 190 (43 newly diagnosed, 68 refractory, and 79 relapsed) patients with AML are reported here. RESULTS In the newly diagnosed AML, the overall response rate and survival confirmed the brilliant results demonstrated in VIALE-A. In the relapsed or refractory AML, the combination demonstrated a surprisingly complete remission rate (44.1% in refractory and 39.7% in relapsed evaluable patients) and conferred to treated patients a good expectation of survival. Toxicities were overall manageable, and most incidents occurred in the first 60 days of therapy. Infections were confirmed as the most common nonhematologic adverse event. CONCLUSIONS Real-life data show that the combination of venetoclax and HMA offers an expectation of remission and long-term survival to elderly, newly diagnosed patients, and to relapsed or chemoresistant AML, increasing the chance of cure through a different mechanism of action. The venetoclax + HMA combination is expected to constitute the base for triplet combinations and integration of target therapies. Our data contribute to ameliorate the understanding of venetoclax + HMA effectiveness and toxicities in real life.
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Affiliation(s)
- Elisabetta Todisco
- Divisione di Oncoematologia, IRCCS Istituto Europeo di Oncologia, Milano, Italy.,SC Ematologia, Ospedale Busto Arsizio, ASST Valle Olona, Varese, Italy
| | - Cristina Papayannidis
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Bologna, Italy
| | - Nicola Fracchiolla
- UOC Oncoematologia, Fondazione IRCCS "Ca'Granda" Ospedale Maggiore Policlinico, Milano, Italy
| | - Elisabetta Petracci
- Unità di Biostatistica e Clinical Trials, IRCCS Istituto Romagnolo per lo Studio dei Tumori (ISRT) "Dino Amadori", Meldola, Italy
| | - Chiara Zingaretti
- Unità di Biostatistica e Clinical Trials, IRCCS Istituto Romagnolo per lo Studio dei Tumori (ISRT) "Dino Amadori", Meldola, Italy
| | - Calogero Vetro
- Divisione di Ematologia, AOU Policlinico "G. Rodolico-San Marco", Catania, Italy
| | - Maria Paola Martelli
- Dipartimento di Medicina e Chirurgia, Università di Perugia, Ospedale "Santa Maria della Misericordia", Perugia, Italy
| | - Patrizia Zappasodi
- Dipartimento di Oncoematologia, Fondazione IRCCS Policlinico "San Matteo", Pavia, Italy
| | - Nicola Di Renzo
- Unità di Ematologia e TCS, Ospedale "Vito Fazzi", Lecce, Italy
| | - Susanna Gallo
- SCDU di Ematologia e Terapie Cellulari, AO Ordine Mauriziano, Torino, Italy
| | - Ernesta Audisio
- SC Ematologia 2, AOU Città della Salute e della Scienza, Torino, Italy
| | | | - Claudio Cerchione
- Dipartimento di Oncologia ed Ematologia Clinica e Sperimentale, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Carmine Selleri
- UOC Ematologia, AOU "San Giovanni di Dio e Ruggi D'Aragona", Salerno, Italy
| | - Daniele Mattei
- SC di Ematologia, AO "Santa Croce e Carle", Cuneo, Italy
| | - Massimo Bernardi
- UO Ematologia e Centro Trapianto di Midollo Osseo, IRCCS Ospedale "San Raffaele", Milano, Italy
| | - Monica Fumagalli
- SC Ematologia, Ospedale "San Gerardo", ASST di Monza, Monza, Italy
| | - Giuliana Rizzuto
- UOC Ematologia e Centro Trapianto di Midollo Osseo, ASST "Papa Giovanni XXIII", Bergamo, Italy
| | - Luca Facchini
- UOC Ematologia, Azienda USL IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Ilenia Manfra
- UO Ematologia, Azienda Ospedaliera "S. G. Moscati", Avellino, Italy
| | - Erika Borlenghi
- UO Ematologia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Roberto Cairoli
- SC Ematologia, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Prassede Salutari
- UOC Ematologia Clinica, Ospedale Civile "Santo Spirito", Pescara, Italy
| | - Michele Gottardi
- Dipartimento di Oncologia, UOC Oncoematologia, Istituto Oncologico Veneto (IOV) IRCCS, Padova, Italy
| | | | | | - Monia Lunghi
- SCDU Ematologia, AOU "Maggiore della Carità", Novara, Italy
| | - Luana Fianchi
- UOC Ematologia e TCSE, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Roma, Italy
| | - Daniela Cilloni
- Dipartimento di Scienze Cliniche e Biologiche, Università di Torino, Torino, Italy
| | - Francesco Lanza
- UO Ematologia, Ospedale "Santa Maria delle Croci", AUSL Romagna, Ravenna, Italy
| | - Elisabetta Abruzzese
- Dipartimento di Ematologia, Ospedale "S. Eugenio", Università Tor Vergata, Roma, Italy
| | - Nicola Cascavilla
- UO Ematologia, Ospedale "Casa Sollievo della Sofferenza" IRCCS, San Giovanni Rotondo, Italy
| | - Flavia Rivellini
- UOC Oncoematologia, Presidio Ospedaliero "A. Tortora", Pagani, Italy
| | | | - Luca Maurillo
- Dipartimento di Biomedicina e Prevenzione, Università Tor Vergata, Roma, Italy
| | - Jacopo Nanni
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Bologna, Italy
| | - Alessandra Romano
- Divisione di Ematologia, AOU Policlinico "G. Rodolico-San Marco", Catania, Italy
| | - Valeria Cardinali
- Dipartimento di Medicina e Chirurgia, Università di Perugia, Ospedale "Santa Maria della Misericordia", Perugia, Italy
| | - Federica Gigli
- Divisione di Oncoematologia, IRCCS Istituto Europeo di Oncologia, Milano, Italy
| | - Elisa Roncoroni
- Dipartimento di Oncoematologia, Fondazione IRCCS Policlinico "San Matteo", Pavia, Italy
| | | | - Giovanni Marconi
- Dipartimento di Oncologia ed Ematologia Clinica e Sperimentale, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Roberta Volpi
- Unità di Biostatistica e Clinical Trials, IRCCS Istituto Romagnolo per lo Studio dei Tumori (ISRT) "Dino Amadori", Meldola, Italy
| | - Mariarita Sciumè
- UOC Oncoematologia, Fondazione IRCCS "Ca'Granda" Ospedale Maggiore Policlinico, Milano, Italy
| | - Corrado Tarella
- Divisione di Oncoematologia, IRCCS Istituto Europeo di Oncologia, Milano, Italy
| | - Giuseppe Rossi
- UO Ematologia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Giovanni Martinelli
- Dipartimento di Oncologia ed Ematologia Clinica e Sperimentale, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
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