scholarly journals Reduced-Intensity Allogeneic Hematopoietic Transplantation Should Be Considered a Standard of Care for Older Patients with Acute Myeloid Leukemia

2011 ◽  
Vol 17 (12) ◽  
pp. 1723-1724 ◽  
Author(s):  
Richard Champlin
Keyword(s):  
Acute Myeloid Leukemia ◽  
Older Patients ◽  
Myeloid Leukemia ◽  
Standard Of Care ◽  
Hematopoietic Transplantation ◽  
Allogeneic Hematopoietic Transplantation ◽  
Reduced Intensity ◽  
Acute Myeloid

scholarly journals Myeloablative Versus Reduced-Intensity Hematopoietic Cell Transplantation for Acute Myeloid Leukemia and Myelodysplastic Syndromes

2017 ◽  
Vol 35 (11) ◽  
pp. 1154-1161 ◽  
Author(s):  
Bart L. Scott ◽  
Marcelo C. Pasquini ◽  
Brent R. Logan ◽  
Juan Wu ◽  
Steven M. Devine ◽  
...  
Keyword(s):  
Acute Myeloid Leukemia ◽  
Cell Transplantation ◽  
Myelodysplastic Syndromes ◽  
Myeloid Leukemia ◽  
Hematopoietic Cell Transplantation ◽  
Standard Of Care ◽  
Hematopoietic Cell ◽  
Phase Iii ◽  
Reduced Intensity ◽  
Acute Myeloid

Purpose The optimal regimen intensity before allogeneic hematopoietic cell transplantation (HCT) is unknown. We hypothesized that lower treatment-related mortality (TRM) with reduced-intensity conditioning (RIC) would result in improved overall survival (OS) compared with myeloablative conditioning (MAC). To test this hypothesis, we performed a phase III randomized trial comparing MAC with RIC in patients with acute myeloid leukemia or myelodysplastic syndromes. Patients and Methods Patients age 18 to 65 years with HCT comorbidity index ≤ 4 and < 5% marrow myeloblasts pre-HCT were randomly assigned to receive MAC (n = 135) or RIC (n = 137) followed by HCT from HLA-matched related or unrelated donors. The primary end point was OS 18 months post–random assignment based on an intent-to-treat analysis. Secondary end points included relapse-free survival (RFS) and TRM. Results Planned enrollment was 356 patients; accrual ceased at 272 because of high relapse incidence with RIC versus MAC (48.3%; 95% CI, 39.6% to 56.4% and 13.5%; 95% CI, 8.3% to 19.8%, respectively; P < .001). At 18 months, OS for patients in the RIC arm was 67.7% (95% CI, 59.1% to 74.9%) versus 77.5% (95% CI, 69.4% to 83.7%) for those in the MAC arm (difference, 9.8%; 95% CI, −0.8% to 20.3%; P = .07). TRM with RIC was 4.4% (95% CI, 1.8% to 8.9%) versus 15.8% (95% CI, 10.2% to 22.5%) with MAC ( P = .002). RFS with RIC was 47.3% (95% CI, 38.7% to 55.4%) versus 67.8% (95% CI, 59.1% to 75%) with MAC ( P < .01). Conclusion OS was higher with MAC, but this was not statistically significant. RIC resulted in lower TRM but higher relapse rates compared with MAC, with a statistically significant advantage in RFS with MAC. These data support the use of MAC as the standard of care for fit patients with acute myeloid leukemia or myelodysplastic syndromes.

scholarly journals Therapeutic Choice in Older Patients with Acute Myeloid Leukemia: A Matter of Fitness

Cancers ◽  
2020 ◽  
Vol 12 (1) ◽  
pp. 120
Author(s):  
Raffaele Palmieri ◽  
Giovangiacinto Paterno ◽  
Eleonora De Bellis ◽  
Lisa Mercante ◽  
Elisa Buzzatti ◽  
...  
Keyword(s):  
Acute Myeloid Leukemia ◽  
Older Patients ◽  
Myeloid Leukemia ◽  
Performance Status ◽  
Standard Of Care ◽  
The Elderly ◽  
Treatment Choice ◽  
Conditioning Treatment ◽  
Approved Drugs ◽  
Acute Myeloid

Acute myeloid leukemia (AML), with an incidence increasing with age, is the most common acute leukemia in adults. Concurrent comorbidities, mild to severe organ dysfunctions, and low performance status (PS) are frequently found in older patients at the onset, conditioning treatment choice and crucially influencing the outcome. Although anthracyclines plus cytarabine-based chemotherapy, also called “7 + 3” regimen, remains the standard of care in young adults, its use in patients older than 65 years should be reserved to selected cases because of higher incidence of toxicity. These adverse features of AML in the elderly underline the importance of a careful patient assessment at diagnosis as a critical tool in the decision-making process of treatment choice. In this review, we will describe selected recently approved drugs as well as examine prognostic algorithms that may be helpful to assign treatment in elderly patients properly.

Use of Reduced Intensity Conditioning (RIC) Regimens Are Associated with a Better Outcome with Sibling Donors Transplants in Older Patients (> 50 years) with Acute Myeloid Leukemia (AML)

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 3307-3307 ◽  
Author(s):  
Biju George ◽  
Ian Kerridge ◽  
Gillian Huang ◽  
David J Gottlieb ◽  
Mark Hertzberg ◽  
...  
Keyword(s):  
Acute Myeloid Leukemia ◽  
T Cell ◽  
Older Patients ◽  
Myeloid Leukemia ◽  
Reduced Intensity Conditioning ◽  
Unrelated Donors ◽  
Conditioning Regimens ◽  
Reduced Intensity ◽  
Acute Myeloid

Abstract Reduced intensity conditioning regimens are increasingly been used in patients aged more than 50 years because of the reduced toxicity associated with these regimens. We compared the outcome of myeloablative (MAT) with reduced intensity (RIC) transplants performed at our centre between 1998 and 2008 for patients older than 50 years with acute myeloid leukemia (AML). Twenty five patients with a median age of 53 years (range: 50– 62) underwent MAT while 26 (median age: 56 yrs [range: 50–65] underwent a RIC transplant. Eight patients undergoing MAT and 9 undergoing RIC were in first remission (CR1) (p = 0.843). Unrelated donors were used in 44% of MAT and 40% of RIC transplants. Conditioning regimens used for MAT included combination of either Busulfan (Bu) with Cyclophosphamide (Cy) or Cy with Total Body irradiation (TBI) while RIC consisted of Fludarabine in combination with either Cy[120 mg/kg], Bu [10 mg/kg] or Melphalan (Mel) [140 mg/m2]. Peripheral blood stem cells (PBSC) were the graft source in all RIC and 76% of MAT transplants. T cell depletion with ATG occurred in 13 MAT transplants [11 MUD and 2 single antigen mismatched sibling] while RIC transplants used either ATG (n = 4 [15.3%]) or Campath (n = 6; [23%]) for T cell depletion [10 MUD]. Three patients undergoing MAT transplant expired due to infection on days 12, 15 and 21 with no evidence of engraftment while 22 (88%) engrafted with a median time to ANC > 0.5 x 109/L of 16.1 days (range: 12 – 23). Among RIC, all patients engrafted with a median time to neutrophil engraftment of 15.6 days (range: 10 – 25). The incidence of acute graft versus host disease (GVHD) in patients with sibling donors was 62% in MAT and 50% in RIC (p = 0.296) while in patients with MUD donors, it was 91% with MAT and 40% with RIC (p = 0.013). Grade II–IV GVHD however was not significantly different between MAT (40%) and RIC transplants (30.7%; p =0.49) both for sibling (31% RIC vs 30% MAT p = 0.411) and MUD donors (30% RIC vs 55% MAT; p = 0.256). Day 100 transplant related mortality was 44% among MAT transplants as compared to 19% among RIC transplants (p = 0.05); 6 of the 11 deaths in the MAT arm were due to GVHD (3 sibling, 3 MUD) while 2 out of 5 patients in the RIC arm expired due to GVHD (p = NS). Chronic GVHD was seen in 26% of MAT and 50% of RIC transplants (p = 0.156) Relapses occurred in 4 patients each among MAT and RIC transplants. At a median follow up of 31 months (range: 1 – 85), the overall (OS) and leukemia free survival (LFS) for MAT transplants were 28% and 24% respectively and for RIC transplants 65% and 54% (p <0.01 and 0.02 respectively). This difference remained significant for patients with sibling donors [OS -75% with RIC vs 21.4% with MAT (p = 0.003); LFS 62.5% with RIC and 7.1% with MAT (p = 0.002)] but not for those with MUD donors [OS - 50% with RIC vs 36.3% with MAT (p = 0.528); LFS 40% with RIC and 36.3% with MAT (p = 0.279)]. The median follow up among survivors was 40.4 months (range: 3 – 85) for the MAT transplants and 39.2 months (range: 5 – 85) for RIC. The use of RIC regimens is associated with a superior survival in older patients with AML with a sibling donor and with equivalent survival in patients with a MUD donor. A larger number of patients need to be studied to ensure that RIC transplants are not inferior to MAT transplants for older AML patients with unrelated donors. Until then, RIC transplants should be recommended for those over 50 years with AML undergoing allogeneic stem cell transplantation.

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