Older Patients with Core Binding Factor AML Do Less Well Over Longer Term

Last Updated: 2009-09-22 13:49:52 -0400 (Reuters Health)

By Scott Baltic

NEW YORK (Reuters Health) - Although patients over 60 with core binding factor acute myeloid leukemia (CBF-AML) are about as likely as younger patients to have a complete response after initial chemotherapy, they have a high risk of relapse and a poor long-term survival rate. Perhaps, French researchers suggest, more intensive therapy should be offered to some of these older patients.

Based on his research team""s findings, Dr. Norbert Vey of the Institut Paoli-Calmettes, Marseille, told Reuters Health by e-mail, an intensive course of chemotherapy induction should be considered for elderly patients with CBF-AML. Their comparatively higher relapse rate, he explained, is probably because they often are not offered the intensive chemotherapy that has proved useful in younger patients with CBF-AML.

CBF-AML occurs in patients who harbor either of two specific chromosomal abnormalities: translocation (8;21) or inversion (16). The incidence of CBF-AML declines with age, accounting for less than 5% percent of occurrences in people 60 and older, according to Dr. Vey and his colleagues.

In fact, the researchers note, their retrospective analysis, reported online in the Journal of Clinical Oncology, is the largest study of elderly CBF-AML patients to date.

The investigators analyzed 147 older patients who received at least one course of induction therapy for CBF-AML with anthracycline plus cytarabine. Their median age was 67 years; 41 (28%) were 70 or older.

The 129 patients who had complete responses then received either maintenance therapy with low-dose cytarabine, methotrexate, and mercaptopurine, or intensive therapy with intermediate- to high-dose cytarabine or high-dose melphalan.

The 88% complete response rate, the authors report, "is comparable" to rates in younger patients.

During a median follow-up of 48 months, the 5-year probabilities of overall survival and leukemia-free survival were 31% and 26%, respectively. Median overall survival was 24 months, and median disease-free survival was 18 months.

Intensive consolidation was associated with better leukemia-free survival, but only in patients with translocation (8;21), according to the researchers.

On multivariate analysis, only a second complete response was linked with longer post-relapse survival.

"Our results suggest that, for CBF-AML, intensive salvage therapy should be considered in particular in patients with inv (16) and a first complete response duration greater than 12 months," the authors write.

"The high risk of relapse suggests that alternative strategies of postremission therapy are warranted," they add.

"Our study has two levels of implications," Dr. Vey continued. "The data generated from this large series of a rare disease represent a landmark for the design of alternative treatment strategies which are strongly needed for this group of patients."

More globally, he said, for elderly patients with cancer, "risk-benefit evaluation is more critical than... for other age groups, and more difficult, since comorbidities and reduced functional reserves play an important role."

Source:

J Clin Oncol 2009.


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