1
|
Oliva EN, Candoni A, Salutari P, Palumbo GA, Reda G, Iannì G, Tripepi G, Cuzzola M, Capelli D, Mammì C, Alati C, Cannatà MC, Niscola P, Serio B, Musto P, Vigna E, Volpe A, Melillo LMA, Arcadi MT, Mannina D, Zannier ME, Latagliata R. Azacitidine Post-Remission Therapy for Elderly Patients with AML: A Randomized Phase-3 Trial (QoLESS AZA-AMLE). Cancers (Basel) 2023; 15:cancers15092441. [PMID: 37173908 PMCID: PMC10177242 DOI: 10.3390/cancers15092441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/11/2023] [Accepted: 04/21/2023] [Indexed: 05/15/2023] Open
Abstract
This phase-3 randomized multicenter trial evaluated the efficacy of subcutaneous azacitidine (AZA) post-remission therapy vs. best supportive care (BSC) in elderly acute myeloid leukemia (AML) patients. The primary endpoint was the difference in disease-free survival (DFS) from complete remission (CR) to relapse/death. Patients with newly diagnosed AML aged ≥61 years received two courses of induction chemotherapy ("3+7" daunorubicin and cytarabine) followed by consolidation (cytarabine). At CR, 54 patients were randomized (1:1) to receive BSC (N = 27) or AZA (N = 27) at a dose of 50 mg/m2 for 7 days every 28 days and the dose increased after the 1st cycle to 75 mg/m2 for a further 5 cycles, followed by cycles every 56 days for 4.5 years. At 2 years, median DFS was 6.0 (95% CI: 0.2-11.7) months for patients receiving BSC vs. 10.8 months (95% CI: 1.9-19.6, p = 0.20) months for AZA. At 5 years, DFS was 6.0 (95% CI: 0.2-11.7) months in the BSC arm vs. 10.8 (95% CI: 1.9-19.6, p = 0.23) months in the AZA arm. Significant benefit was afforded by AZA on DFS at 2 and 5 years in patients aged >68 years (HR = 0.34, 95% CI: 0.13-0.90, p = 0.030 and HR = 0.37, 95% CI: 0.15-0.93, p = 0.034, respectively). No deaths occurred prior to leukemic relapse. Neutropenia was the most frequent adverse event. There were no differences in patient-reported outcome measures between study arms. In conclusion, AZA post-remission therapy was found to provide benefit in AML patients aged >68 years.
Collapse
Affiliation(s)
- Esther Natalie Oliva
- U.O.C. Ematologia, Grande Ospedale Metropolitano Bianchi Melacrino Morelli, 89124 Reggio di Calabria, Italy
| | - Anna Candoni
- Divisione Ematologia, P.O. Santa Maria della Misericordia, A.S.U.F.C di Udine, 33100 Udine, Italy
| | - Prassede Salutari
- Dipartimento Oncologico-Ematologico Ospedale Civile Spirito Santo Pescara, 65124 Pescara, Italy
| | - Giuseppe A Palumbo
- Dipartimento di Scienze Mediche Chirurgiche e Tecnologie Avanzate "G.F. Ingrassia", University of Catania, 95123 Catania, Italy
| | - Gianluigi Reda
- UOC Ematologia Università degli Studi di Milano, IRCCS Ospedale Maggiore Policlinico Milano, 20133 Milano, Italy
| | - Giuseppe Iannì
- Dielnet SRL, CRO Reggio Calabria, 89124 Reggio Calabria, Italy
| | - Giovanni Tripepi
- IFC-CNR Institute of Clinical Physiology Reggio Calabria, 89124 Reggio Calabria, Italy
| | - Maria Cuzzola
- UOSD Tipizzazione Tissutale, Grande Ospedale Metropolitano Bianchi Melacrino Morelli, 89124 Reggio di Calabria, Italy
| | - Debora Capelli
- Clinica di Ematologia Azienda Ospedaliera Universitaria, Ospedali Riuniti di Ancona, 60126 Ancona, Italy
| | - Corrado Mammì
- UOSD Medical Genetics, Great Metropolitan Hospital, 89124 Reggio Calabria, Italy
| | - Caterina Alati
- U.O.C. Ematologia, Grande Ospedale Metropolitano Bianchi Melacrino Morelli, 89124 Reggio di Calabria, Italy
| | | | | | - Bianca Serio
- Dipartimento di Oncoematologia, AOU San Giovanni di Dio e Ruggi D'Aragona, 84125 Salerno, Italy
| | - Pellegrino Musto
- Department of Precision and Translational Medicine with Ionian Area, "Aldo Moro" University School of Medicine, 70121 Bari, Italy
- Unit of Hematology and Stem Cell Transplantation, AOUC Policlinico, 70124 Bari, Italy
| | - Ernesto Vigna
- U.O. di Ematologia, Ospedale L'Annunziata, 87100 Cosenza, Italy
| | - Antonio Volpe
- U.O. di Ematologia, Azienda Ospedaliera San Giuseppe Moscato, 83100 Avellino, Italy
| | - Lorella Maria Antonia Melillo
- U.O.C. Ematologia e Trapianto di Cellule Staminali Emopoietiche, Policlinico Foggia Ospedaliero-Universitario, 71122 Foggia, Italy
| | - Maria Teresa Arcadi
- U.O. Farmacia, Grande Ospedale Metropolitano Bianchi Melacrino Morelli, 89124 Reggio di Calabria, Italy
| | - Donato Mannina
- U.O.C. di Ematologia, Azienda Ospedaliera Papardo, 98158 Messina, Italy
| | - Maria Elena Zannier
- Divisione Ematologia, P.O. Santa Maria della Misericordia, A.S.U.F.C di Udine, 33100 Udine, Italy
| | | |
Collapse
|
2
|
Cai B, Wang Y, Lei Y, Shi Y, Sun Q, Qiao J, Hu K, Lei Y, Li B, Liu T, Liu Z, Yao B, Zhao X, Li X, Zhao W, Feng X, Xie A, Ning X, Feng M, Zhao W, Guo J, Ai H, Yu C, Guo M. Hyper-CVAD-Based Stem Cell Microtransplant as Post-Remission Therapy in Acute Lymphoblastic Leukemia. Stem Cells Transl Med 2022; 11:1113-1122. [PMID: 36181762 DOI: 10.1093/stcltm/szac066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 08/18/2022] [Indexed: 11/14/2022] Open
Abstract
Post-remission strategies for patients with acute lymphoblastic leukemia (ALL) are limited to the multiagent chemotherapy and allogeneic stem cell transplant (allo-SCT), and cellular therapies are seldom involved. Although chemotherapy combined with mismatched granulocyte colony-stimulating factor mobilized peripheral blood mononuclear cell infusion (microtransplant, MST) has been studied in patients with acute myeloid leukemia, its efficacy in ALL is still undetermined. We enrolled 48 patients receiving hyper-CVAD-based MST between July 1, 2009, and January 31, 2018. No acute or chronic graft-versus-host disease occurred in patients receiving MST. Four-year overall survival (OS) and leukemia-free survival (LFS) were 62% and 35%, respectively, and the 4-year relapse rate was 65%. No patient experienced non-relapse mortality. Subgroup analysis showed that OS rates were comparable between groups with different age, risk stratification, minimal residual disease status prior to MST and immunophenotype. Adult patients tended to achieve better 4-year LFS (62% vs. 26%, P = .058) and lower hematologic relapse rate (38% vs. 74%, P = .058) compared with adolescent and young adult patients. Donor chimerism/microchimerism was detectable ranging from 0.002% to 42.78% in 78% (42/54) available samples within 14 days after each infusion and at 3 months or one year after the last cell infusion. Multivariate analyses demonstrated that white blood cells <30 × 109/L at diagnosis and sufficient hyper-CVAD cycles were prognostic factors for better 4-year OS and LFS, while the B-cell phenotype and higher number of infused CD34+ cells in the first cycle were predictors for favorable 4-year LFS. The hyper-CVAD-based MST was a feasible strategy for treating ALL patients with mild toxicity.
Collapse
Affiliation(s)
- Bo Cai
- Department of Hematology, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Yi Wang
- Department of Hematology, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Yangyang Lei
- Department of Hematology, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Yanping Shi
- Department of Hematology, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Qiyun Sun
- Department of Hematology, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Jianhui Qiao
- Department of Hematology, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Kaixun Hu
- Department of Hematology, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Yaqing Lei
- Department of Hematology, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Bingxia Li
- Department of Hematology, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Tieqiang Liu
- Department of Hematology, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Zhiqing Liu
- Department of Hematology, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Bo Yao
- Department of Hematology, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Xuecong Zhao
- Department of Hematology, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Xiaofei Li
- Department of Hematology, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Wen Zhao
- Department of Hematology, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Xiujie Feng
- Department of Hematology, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Anli Xie
- Department of Hematology, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Xin Ning
- Department of Hematology, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Mingxing Feng
- Department of Hematology, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Weiwei Zhao
- Department of Hematology, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Jiayue Guo
- Department of Clinical Medicine, Capital Medical University, Beijing, People's Republic of China
| | - Huisheng Ai
- Department of Hematology, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Changlin Yu
- Department of Hematology, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Mei Guo
- Department of Hematology, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China
| |
Collapse
|
3
|
Ferrara F, Picardi A. Is There Still a Role for Autologous Stem Cell Transplantation for the Treatment of Acute Myeloid Leukemia? Cancers (Basel) 2019; 12:E59. [PMID: 31878297 DOI: 10.3390/cancers12010059] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 12/20/2019] [Accepted: 12/23/2019] [Indexed: 12/12/2022] Open
Abstract
After intensive induction chemotherapy and complete remission achievement, patients with acute myeloid leukemia (AML) are candidates to receive either high-dose cytarabine-based regimens, or autologous (ASCT) or allogeneic (allo-SCT) hematopoietic stem cell transplantations as consolidation treatment. Pretreatment risk classification represents a determinant key of type and intensity of post-remission therapy. Current evidence indicates that allo-SCT represents the treatment of choice for high and intermediate risk patients if clinically eligible, and its use is favored by increasing availability of unrelated or haploidentical donors. On the contrary, the adoption of ASCT is progressively declining, although numerous studies indicate that in favorable risk AML the relapse rate is lower after ASCT than chemotherapy. In addition, the burden of supportive therapy and hospitalization favors ASCT. In this review, we summarize current indications (if any) to ASCT on the basis of molecular genetics at diagnosis and minimal residual disease evaluation after induction/consolidation phase. Finally, we critically discuss the role of ASCT in older patients with AML and acute promyelocytic leukemia.
Collapse
|