Comparative analysis of azacitidine and intensive chemotherapy as front-line treatment of elderly patients with acute myeloid leukemia

Luca Maurillo, Francesco Buccisano, Alessandra Spagnoli, Maria Teresa Voso, Luana Fianchi, Cristina Papayannidis, Gian Luca Gaidano, Massimo Breccia, Pellegrino Musto, Eleonora De Bellis, Maria Ilaria Del Principe, Monia Lunghi, Federica Lessi, Giovanni Martinelli, Adriano Venditti

Research output: Contribution to journalArticlepeer-review


The present observational study aimed to compare the efficacy of azacitidine (AZA) and intensive chemotherapy (IC) in elderly patients with untreated acute myeloid leukemia (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 group included 89 patients; median age was 73 years (range 61–80) and median white blood cell count (WBCc) 2.5 × 109/L (range 0.27–83), 45% of the patients had BM blasts ≥ 30%, and 44 (49%) had a secondary AML (sAML). Karyotype was evaluable in 69 patients: 51 (74%) had intermediate-risk abnormalities and 18 (26%) an unfavorable risk karyotype. IC group consisted of 110 patients who received an induction course with mitoxantrone, cytarabine, and etoposide, followed by two consolidation cycles including idarubicin, cytarabine, and etoposide. Median age was 67 years (range 61–78) and median WBCc 8.0 × 109/L (range 0.69–258); 44 (40%) had a sAML. Karyotype was evaluable in 88 patients, 71 (81%) had intermediate risk, and 17 (19%) unfavorable risk karyotype. To minimize the effects of treatment selection bias, adjustments were made using the propensity-score matching method, which yielded 74 patient pairs. CR rate was significantly higher in IC vs AZA group (73 vs 25%, respectively) (p < 0.0001), but the 3-year OS rates and median OS were not significantly different (21.6 vs 11% and 15.8 vs 13 months, respectively). Our analysis suggests similar outcomes with AZA compared to IC. Controlled, randomized clinical trials are warranted to confirm this conclusion.

Original languageEnglish
Pages (from-to)1767-1774
Number of pages8
JournalAnnals of Hematology
Issue number10
Publication statusPublished - Oct 1 2018


  • Acute myeloid leukemia
  • Azacitidine
  • Elderly
  • Intensive chemotherapy

ASJC Scopus subject areas

  • Hematology


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