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Büchner T, Krug UO, Peter Gale R, Heinecke A, Sauerland MC, Haferlach C, Schnittger S, Haferlach T, Müller-Tidow C, Stelljes M, Mesters RM, Serve HL, Braess J, Spiekermann K, Staib P, Grüneisen A, Reichle A, Balleisen L, Eimermacher H, Giagounidis A, Rasche H, Lengfelder E, Görlich D, Faldum A, Köpcke W, Hehlmann R, Wörmann BJ, Berdel WE, Hiddemann W. Age, not therapy intensity, determines outcomes of adults with acute myeloid leukemia. Leukemia 2016; 30:1781-4. [PMID: 26965440 DOI: 10.1038/leu.2016.54] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- T Büchner
- Department of Medicine A, Hematology, Oncology and Pneumology, University of Münster, Münster, Germany
| | - U O Krug
- Department of Hematology and Oncology, Klinikum Leverkusen; Leverkusen, Germany
| | - R Peter Gale
- Division of Experimental Medicine, Department of Medicine, Haematology Research Centre, Imperial College London, London, UK
| | - A Heinecke
- Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany
| | - M C Sauerland
- Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany
| | - C Haferlach
- MLL Munich Leukemia Laboratory, Munich, Germany
| | | | - T Haferlach
- MLL Munich Leukemia Laboratory, Munich, Germany
| | - C Müller-Tidow
- Department of Medicine A, Hematology, Oncology and Pneumology, University of Münster, Münster, Germany
| | - M Stelljes
- Department of Medicine A, Hematology, Oncology and Pneumology, University of Münster, Münster, Germany
| | - R M Mesters
- Department of Medicine A, Hematology, Oncology and Pneumology, University of Münster, Münster, Germany
| | - H L Serve
- Department of Hematology and Oncology, University of Frankfurt, Germany
| | - J Braess
- Department of Hematology and Oncology, Krankenhaus Barmherzige Brüder, Regensburg, Germany
| | - K Spiekermann
- Department of Internal Medicine III, University Hospital Munich, Grosshadern, Munich, Germany
| | - P Staib
- Department of Hematology and Oncology, St -Antonius Hospital, Eschweiler, Germany
| | - A Grüneisen
- Department of Hematology and Oncology, Vivantes Clinic Neukölln, Berlin, Germany
| | - A Reichle
- Department of Hematology and Oncology, University Regensburg, Regensburg, Germany
| | - L Balleisen
- Department of Hematology and Oncology, Evangelisches Krankenhaus, Hamm, Germany
| | - H Eimermacher
- Department of Hematology and Oncology, KKH St Marien Hospital, Hagen, Germany
| | - A Giagounidis
- Marienhospital Düsseldorf, Clinic for Oncology, Hematology and Palliative Care, Düsseldorf, Germany
| | - H Rasche
- Department of Hematology and Oncology, Klinikum Bremen-Mitte, Bremen, Germany
| | - E Lengfelder
- Department of Hematology and Oncology, University of Heidelberg, Mannheim, Germany
| | - D Görlich
- Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany
| | - A Faldum
- Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany
| | - W Köpcke
- Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany
| | - R Hehlmann
- Department of Hematology and Oncology, University of Heidelberg, Mannheim, Germany
| | - B J Wörmann
- German Society of Hematology and Oncology, Berlin, Germany
| | - W E Berdel
- Department of Medicine A, Hematology, Oncology and Pneumology, University of Münster, Münster, Germany
| | - W Hiddemann
- Department of Internal Medicine III, University Hospital Munich, Grosshadern, Munich, Germany
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Buchner T, Berdel WE, Haferlach C, Haferlach T, Schnittger S, Serve HL, Sauerland MC, Heinecke A, Wörmann B, Hiddemann W. Older-age AML: Disease biology and dose response. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.7058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7058 Background: In 2602 pts entering two sequential trials the 47% pts of 60+y compared to the younger pts achieved 55 vs 71% CR, 19 vs 41% OS and 77 vs 54% RR (relapse risk) at 3 years. While the trials addressed various options for both de-novo and secondary AML understanding the age related biology of AML required restriction to pts comparable in history, therapy and availability of risk factors. Methods: We therefore selected from the two trials pts with de-novo AML and known karyotype assigned to one of two different intensity induction regimens, either TAD-HAM (HAM, high-dose araC 3(age <60) and 1(age 60+) g/m2x6), or HAM-HAM. All pts received TAD consolidation and monthly reduced TAD maintenance. Results: In the 1284 selected pts the CR rate is 60% in pts of 60+y and 70% in those of 16 −<60y (p<.001), the OS is 23 vs 41% (log rank p<0.001) and the RR is 73 vs 50% (p<.001). There are advantages for younger pts in favorable (16 vs 7%) and unfavorable (18 vs 24%) karyotypes (p<.001) whereas WBC (p=.002) and LDH (p=.002) are lower in the older pts. Among normal karyotypes (52%) the favorable NPM mutation in absence of Flt3 mutation account for 33% of NPM/Flt3 combinations in older and 37% in younger pts (n.s.). The inferior CR, OS and RR in the older vs younger pts is seen in all prognostic subgroups. Thus, the OS at 3 years is 36 vs 62% in favorable (p=.001), 2 vs 14% in unfavorable karyotypes (p=.001), 25 vs 42% in low WBC (p<.001), 21 vs 38% in high WBC (p<.001), 23 vs 42% in low LDH (p<.001), 16 vs 38% in high LDH (p<.001), 30 vs 43% in low day 16 blasts (p<.001), 19 vs 38% in high day 16 blasts (p<.001) and even 50 vs 63% in pts with NPM+/Flt3- mutation (p=.020). In contrast, outcome does not vary by randomization for TAD-HAM vs HAM-HAM chemotherapy. Conclusions: The lack of dose response and the modest age related differences in defined risk profiles suggest hitherto unknown determinants of the poor outcome in older age AML across all subsets. These experiences may indicate the way toward novel experimental options instead of further escalation. No significant financial relationships to disclose.
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Affiliation(s)
- T. Buchner
- University Medical Center, Munster, Germany; Munich Leukemia Laboratory, Munich, Germany; University of Munster, Munster, Germany; Municipal Medical Center, Braunschweig, Germany; University Medical Center, Munich, Germany
| | - W. E. Berdel
- University Medical Center, Munster, Germany; Munich Leukemia Laboratory, Munich, Germany; University of Munster, Munster, Germany; Municipal Medical Center, Braunschweig, Germany; University Medical Center, Munich, Germany
| | - C. Haferlach
- University Medical Center, Munster, Germany; Munich Leukemia Laboratory, Munich, Germany; University of Munster, Munster, Germany; Municipal Medical Center, Braunschweig, Germany; University Medical Center, Munich, Germany
| | - T. Haferlach
- University Medical Center, Munster, Germany; Munich Leukemia Laboratory, Munich, Germany; University of Munster, Munster, Germany; Municipal Medical Center, Braunschweig, Germany; University Medical Center, Munich, Germany
| | - S. Schnittger
- University Medical Center, Munster, Germany; Munich Leukemia Laboratory, Munich, Germany; University of Munster, Munster, Germany; Municipal Medical Center, Braunschweig, Germany; University Medical Center, Munich, Germany
| | - H. L. Serve
- University Medical Center, Munster, Germany; Munich Leukemia Laboratory, Munich, Germany; University of Munster, Munster, Germany; Municipal Medical Center, Braunschweig, Germany; University Medical Center, Munich, Germany
| | - M. C. Sauerland
- University Medical Center, Munster, Germany; Munich Leukemia Laboratory, Munich, Germany; University of Munster, Munster, Germany; Municipal Medical Center, Braunschweig, Germany; University Medical Center, Munich, Germany
| | - A. Heinecke
- University Medical Center, Munster, Germany; Munich Leukemia Laboratory, Munich, Germany; University of Munster, Munster, Germany; Municipal Medical Center, Braunschweig, Germany; University Medical Center, Munich, Germany
| | - B. Wörmann
- University Medical Center, Munster, Germany; Munich Leukemia Laboratory, Munich, Germany; University of Munster, Munster, Germany; Municipal Medical Center, Braunschweig, Germany; University Medical Center, Munich, Germany
| | - W. Hiddemann
- University Medical Center, Munster, Germany; Munich Leukemia Laboratory, Munich, Germany; University of Munster, Munster, Germany; Municipal Medical Center, Braunschweig, Germany; University Medical Center, Munich, Germany
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