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Wu YH, Xiao HY, Quan RC, Tang XD, Liu WY, Lyu Y, Chen Z, Liu C, Hu XM. Comparing Arsenic-Containing Qinghuang Powder and Low-Intensity Chemotherapy in Elderly Patients with Acute Myeloid Leukemia. Chin J Integr Med 2023; 29:832-837. [PMID: 37222831 DOI: 10.1007/s11655-023-3603-6] [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] [Accepted: 02/27/2023] [Indexed: 05/25/2023]
Abstract
OBJECTIVE To compare the clinical effect of arsenic-containing Qinghuang Powder (QHP) and low-intensity chemotherapy (LIC) in treatment of elderly acute myeloid leukemia (eAML) patients. METHODS Clinical data of 80 eAML patients treated at Xiyuan Hospital of China Academy of Chinese Medical Sciences from January 2015 to December 2020 were retrospectively analyzed. The treatment scheme was designed by real world study according to patients' preference, and patients were divided into a QHP group (35 cases) and a LIC group (45 cases). The median overall survival (mOS), 1-, 2-, and 3-year OS rates, and incidence of adverse events were compared between the two groups. RESULTS The mOS of 80 patients was 11 months, and the 1-, 2-, and 3-year OS rates were 45.51%, 17.96%, and 11.05%, respectively. The QHP and LIC groups demonstrated no significant difference in mOS (12 months vs. 10 months), 1- (48.57% vs. 39.65%), 2- (11.43% vs. 20.04%), and 3-year OS rates (5.71% vs. 13.27%, all P>0.05). Moreover, the related factors of mOS demonstrated no significant difference in patients with age>75 years (11 months vs. 8 months), secondary AML (11 months vs. 8 months), poor genetic prognosis (9 months vs. 7 months), Eastern Cooperative Oncology Group performance status score ⩾ 3 (10 months vs. 7 months) and hematopoietic stem cell transplant comorbidity index ⩾ 4 (11 months vs. 7 months) between the QHP and LIC groups (all P>0.05). However, the incidence of myelosuppression was significantly lower in the QHP group than that in the LIC group (28.57% vs. 73.33%, P<0.01). CONCLUSIONS QHP and LIC had similar survival rates in eAML patients, but QHP had a lower myelosuppression incidence. Hence, QHP can be an alternative for eAML patients who do not tolerate LIC.
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Affiliation(s)
- Yu-He Wu
- 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
| | - Hai-Yan Xiao
- Department of Hematology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China
| | - Ri-Cheng Quan
- 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
| | - Wei-Yi Liu
- Department of Hematology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China
| | - Yan Lyu
- Department of Hematology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China
| | - Zhuo Chen
- 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
| | - Xiao-Mei Hu
- Department of Hematology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China.
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Maurillo L, Spagnoli A, Candoni A, Papayannidis C, Borlenghi E, Lazzarotto D, Fianchi L, Sciumè M, Zannier ME, Buccisano F, Del Principe MI, Mancini V, Breccia M, Fanin R, Todisco E, Lunghi M, Palmieri R, Fracchiolla N, Musto P, Rossi G, Venditti A. Comparison between azacitidine and decitabine as front-line therapy in elderly acute myeloid leukemia patients not eligible for intensive chemotherapy. Leuk Res 2023; 127:107040. [PMID: 36801702 DOI: 10.1016/j.leukres.2023.107040] [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: 10/22/2022] [Revised: 02/08/2023] [Accepted: 02/10/2023] [Indexed: 02/16/2023]
Abstract
We compared the efficacy of azacitidine (AZA) and decitabine (DEC) in elderly patients with untreated AML, diagnosed according to WHO criteria. In the two groups, we evaluated complete remission (CR), overall survival (OS) and disease free survival (DFS). The AZA and DEC groups included 139 and 186 patients, respectively. To minimize the effects of treatment selection bias, adjustments were made using the propensity-score matching method, which yielded 136 patient pairs. In the AZA and DEC cohort, median age was 75 years in both, (IQR, 71-78 and 71-77), median WBCc at treatment onset 2.5 × 109/L (IQR, 1.6-5.8) and 2.9 × 109/L (IQR, 1.5-8.1), median bone marrow (BM) blast count 30% (IQR, 24-41%) and 49% (IQR, 30-67%), 59 (43%) and 63 (46%) patients had a secondary AML, respectively. Karyotype was evaluable in 115 and 120 patients: 80 (59%) and 87 (64%) had intermediate-risk, 35 (26%) and 33 (24%) an adverse risk karyotype, respectively. Median number of cycles delivered was 6 (IQR, 3.0-11.0) and 4 (IQR, 2.0-9.0), CR rate was 24% vs 29%, median OS and 2-year OS rates 11.3 (95% CI 9.5-13.8) vs 12.0 (95% CI 7.1-16.5) months and 20% vs 24%, respectively. No differences in CR and OS were found within the following subgroup: intermediate- and adverse-risk cytogenetic, frequency of WBCc at treatment ≥ 5 × 10^9 L and < 5 × 10^9/L, de novo and secondary AML, BM blast count < and ≥ 30%. Median DFS for AZA and DEC treated patients was 9.2 vs 12 months, respectively. Our analysis indicates similar outcomes with AZA compared to DEC.
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Affiliation(s)
- L Maurillo
- Division of Hematology, Tor Vergata Foundation Polyclinic, Rome, Italy.
| | - A Spagnoli
- Department of Public Health and Infectious Disease, La Sapienza University, Rome, Italy
| | - A Candoni
- Division of Hematology and SCT, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
| | - C Papayannidis
- Department of Experimental, Diagnostic and Specialty Medicine, Institute of Hematology BL. and A. Seràgnoli, University of Bologna, Bologna, Italy
| | - E Borlenghi
- Hematology, ASST Spedali Civili di Brescia, Brescia, Italy
| | - D Lazzarotto
- Division of Hematology and SCT, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
| | - L Fianchi
- Hematology, Sacro Cuore Catholic University, Rome, Italy
| | - M Sciumè
- Hematology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - M E Zannier
- Division of Hematology and SCT, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
| | - F Buccisano
- Division of Hematology, Tor Vergata Foundation Polyclinic, Rome, Italy; Hematology, Department of Biomedicine e Prevention, Tor Vergata University, Rome, Italy
| | - M I Del Principe
- Division of Hematology, Tor Vergata Foundation Polyclinic, Rome, Italy; Hematology, Department of Biomedicine e Prevention, Tor Vergata University, Rome, Italy
| | - V Mancini
- Dipartimento di Ematologia e Oncologia, Ospedale Niguarda, Milan, Italy
| | - M Breccia
- Division of Cellular Biotechnologies and Hematology, University Sapienza, Rome, Italy
| | - R Fanin
- Division of Hematology and SCT, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
| | - E Todisco
- Hematology and Stem Cell Transplantation Division ASST-Valle Olona, Busto Arsizio, Italy
| | - M Lunghi
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - R Palmieri
- Division of Hematology, Tor Vergata Foundation Polyclinic, Rome, Italy
| | - N Fracchiolla
- Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - P Musto
- Department of Emergency and Organ Transplantation (D.E.T.O.), Hematology and Stem Cell Transplantation Unit, University of Bari "Aldo Moro", Bari, Italy
| | - G Rossi
- Hematology, ASST Spedali Civili di Brescia, Brescia, Italy
| | - A Venditti
- Division of Hematology, Tor Vergata Foundation Polyclinic, Rome, Italy; Hematology, Department of Biomedicine e Prevention, Tor Vergata University, Rome, Italy
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Long-Term Follow-Up of Elderly Patients with Acute Myeloid Leukemia Treated with Decitabine: A Real-World Study of the Apulian Hematological Network. Cancers (Basel) 2022; 14:cancers14030826. [PMID: 35159092 PMCID: PMC8834602 DOI: 10.3390/cancers14030826] [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: 01/13/2022] [Revised: 02/02/2022] [Accepted: 02/04/2022] [Indexed: 11/17/2022] Open
Abstract
Simple Summary This Italian real-life study conducted between 2013 and 2021 and including 199 acute myeloid leukemia (AML) patients demonstrates, after a median follow-up of almost 3 years, how decitabine administered to AML patients not suitable for intensive chemotherapy is effective and well tolerated, even in a population of truly elderly patients with frequent comorbidities. Abstract Decitabine, a DNA hypomethylating agent, was approved for use in adults with acute myeloid leukemia (AML) not eligible for standard chemotherapy and is now widely accepted as standard treatment. Although a number of clinical trials demonstrated its benefits in elderly AML patients, older adults and patients with frequent comorbidities are typically under-represented in such settings. Thus, the aim of the present study is to evaluate, in a real-world setting, the effectiveness and toxicity of decitabine administered as a single agent in unselected previously untreated elderly AML patients not eligible for intensive chemotherapy. In nine hematological departments of the Apulian Hematological Network (REP), we enrolled 199 patients (median age: 75.4 years; range: 61–91) with de novo (n = 94) or secondary/therapy-related (n = 105) AML treated with decitabine 20 mg/m2 for five days every 4 weeks. Hazard ratios (HR) and their 95% confidence intervals (CI) were estimated using multivariate Cox regression. The average number of cycles administered per patient was 6.3 (SD: 6.0; median: 5 cycles). Complete response was achieved by 31 patients (15.6%) and partial response by 57 (28.6%), for a total of 88 responders overall (44.2%). After a median follow-up of 33.6 months, median OS was 8.7 months (95% CI: 7.4–10.3), and the 6-month, 1-year, and 3-year OS rates were 62.7%, 37.0%, and 7.1%, respectively. Mortality was increased in AML patients with ≥3 comorbidities (HR = 2.45; 95% CI: 1.18–5.08) vs. no comorbidities and in those with adverse karyotype (HR = 1.58; 95% CI: 1.05–2.38) vs. favourable or intermediate profile. Infection was the main registered adverse event (46.0%). In conclusion, this REP real-life study demonstrates, after a follow-up of almost 3 years, how decitabine administered to AML patients not suitable for intensive chemotherapy is effective and well tolerated, even in a population of truly elderly patients with frequent comorbidities.
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