Survival of elderly patients with acute myeloid leukemia

Alessandro Pulsoni, Livio Pagano, Roberto Latagliata, Marco Casini, Raffaella Cerri, Monica Crugnola, Lorella De Paoli, Eros Di Bona, Rosangela Invernizzi, Filippo Marmont, Maria Concetta Petti, Gianmatteo Rigolin, Francesca Ronco, Antonio Spadano, Maria Elena Tosti, Giuseppe Visani, Alfonso Mele, Franco Mandelli

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Abstract

Background and Objectives. The prognosis of elderly patients with acute myelogenous leukemia (AML) is usually dismal, while the true survival of older patients not included in clinical trials is not known. We retrospectively evaluated the impact on survival of an aggressive versus a non-aggressive approach in 1005 patients aged >60 years registered in the database of the GIMEMA cooperative group. Design and Methods. Group A patients (n=621) received aggressive treatment, while group B patients (n=384) underwent non-aggressive therapy. The groups were different for risk factor distribution: the patients in group B had a higher median age, worse performance status (PS) and a higher proportion of previous myelodysplastic disease. Results. The overall median survival was 7 and 5 months in groups A and B, respectively (p71 years (RR=1.27; 95% CI=1.07-1.50), PS=2-4 (RR=1.44; 95% CI=1.24-1.68), white cell count >10,000 μL (RR=1.37; 95% CI=1.06-1.75), and heart dysfunction requiring treatment (RR=1.26; 95% CI=1.05-1.50). No difference in survival was associated with aggressive or non-aggressive treatment (RR=1.1; 95% CI=0.94-1.32). Patients aged 10,000/μL showed a significantly better survival when treated aggressively (median survival 7 vs 3 months, p=0.011). Interpretation and Conclusions. Despite an obvious selection of patients with a worse prognosis in group B, the difference in survival between the two groups was marginal. Multivariate analysis failed to demonstrate a significant survival benefit in aggressively treated patients. All these considerations indicate that elderly patients with AML are overall unlikely to benefit from aggressive treatment, so that this should be offered only to selected patients.

Original languageEnglish
Pages (from-to)296-302
Number of pages7
JournalHaematologica
Volume89
Issue number3
Publication statusPublished - Mar 2004

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Keywords

  • Acute myeloid leukemia treatment
  • Elderly
  • Survival

ASJC Scopus subject areas

  • Hematology

Cite this

Pulsoni, A., Pagano, L., Latagliata, R., Casini, M., Cerri, R., Crugnola, M., De Paoli, L., Di Bona, E., Invernizzi, R., Marmont, F., Petti, M. C., Rigolin, G., Ronco, F., Spadano, A., Tosti, M. E., Visani, G., Mele, A., & Mandelli, F. (2004). Survival of elderly patients with acute myeloid leukemia. Haematologica, 89(3), 296-302.