Abstract
The treatment of older patients with acute myeloid leukemia that is secondary to previous myelodysplastic syndrome, myeloproliferative neoplasm, or prior cytotoxic exposure remains unsatisfactory. We compared 92 and 107 patients treated, respectively, with intensive chemotherapy or azacitidine within two centres. Diagnoses were 37.5% post-myelodysplastic syndrome, 17.4% post-myeloproliferative neoplasia, and 45.1% therapy-related acute myeloid leukemia. Patients treated by chemotherapy had less adverse cytogenetics, higher white blood-cell counts, and were younger: the latter two being independent factors entered into the multivariate analyses. Median overall-survival times with chemotherapy and azacitidine were 9.6 (IQR: 3.6−22.8) and 10.8 months (IQR: 4.8−26.4), respectively (p = 0.899). Adjusted time-dependent analyses showed that, before 1.6 years post-treatment, there were no differences in survival times between chemotherapy and azacitidine treatments whereas, after this time-point, patients that received chemotherapy had a lower risk of death compared to those that received azacitidine (adjusted HR 0.61, 95%CI: 0.38−0.99 at 1.6 years). There were no interactions between treatment arms and secondary acute myeloid leukemia subtypes in all multivariate analyses, indicating that the treatments had similar effects in all three subtypes. Although a comparison between chemotherapy and azacitidine remains challenging, azacitidine represents a valuable alternative to chemotherapy in older patients that have secondary acute myeloid leukemia because it provides similar midterm outcomes with less toxicity.
Highlights
The subgroup of patients with non de novo acute myeloid leukemia (AML) is frequently and improperly named as having “secondary” AML
We have described one of the largest cohorts of therapy-related acute myeloid leukemia (t-AML) and secondary AML (sAML) patients aged ≥60 years and selected from daily practice for two different treatment approaches over a 7-year period
We show that patients that received intensive chemotherapy had a better complete response rate, a higher early death rate, and similar median overall survival (OS) times compared to patients that received azacitidine
Summary
The subgroup of patients with non de novo acute myeloid leukemia (AML) is frequently and improperly named as having “secondary” AML This group is heterogeneous and encompasses both therapy-related acute myeloid leukemia (t-AML), which occurs after prior exposure to cytotoxic chemotherapy and/ or radiotherapy, and secondary AML (sAML), which occurs in the course of a previous myeloid disease such as myelodysplastic syndrome (MDS) or Philadelphianegative myeloproliferative neoplasm (MPN) [1]. In most studies, both t-AML and sAML have been associated with a worse prognosis compared to de novo AML, subgroups of patients with a better outcome have been reported [2,3,4]. In patients deemed fit for intensive therapy, which represents less than half of this older-patient population, therapeutic strategies differ little from those for de novo AML: these patients are offered induction chemotherapy and allogeneic stem-cell transplantation (HSCT)
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