Is Consolidation and/or Maintenance Treatment a Standard Therapy in Elderly AML in First Complete Remission?.

Abstract

The treatment of elderly patients with acute myeloid leukemia (AML) is very disappointing. Studies have established that if half of the intensivity treated patients achieve complete remission (CR), the high rate of relapse within the first year jeopardize the long term survival. No clearly effective postremission therapy had been established. Therefore we retrospective analyzed 141 elderly patients (>60 yo) in first CR, to evaluate the effectiveness of postremission therapy, consolidation (3+7or 2+5) and/or maintenance (low dose AraC). All patiens received a 3+7 induction therapy. In these 141 patients DFS and OS at 4 years are respectively 14%, and 19%.According to the clinical status of the patient after induction, 20 (14%) patients did not receive therapy after induction, 30 (21%) patients received only maintenance therapy, 53 (38%) patients received only consolidation therapy, and 38 patients (27%) received both consolidation and maintenance therapy. These 4 groups were stratified according to age (< >70 yo) and WBC (< or > 30 x 109/l) (See Tables). The outcome of these patients receiving or not post induction therapy is shown in these Tables.PatientsDFS at 4 yearsOS at 4 yearsConsolidationNo consolidationP valueconsolidationNo consolidationP value< 70yo and WBC< 30x109/l19%13%p=0.0127%13%p=0.0074<70yo and WBC>30x109/l26%0%p=0.0838%0%p=0.05>70 yo and WBC < 30x109/l0%30%p=0.0016%30%p=0.01>70 yo and WBC> 30x109/l2%0%NS4%0%NSOutcome of patients receiving or not consolidation therapy in 4 groups stratified according to age and WBC countIn patients > 70 yo and WBC < 30 x 109/l patients who received consolidation have a poorer prognosis than patients who did not because the mortality in first complete remission (mortality during consolidation) was high (25% versus 0% respectively, P=0.01).PatientsDFS at 4 yearsOS at 4 yearsMaintenanceNo Maintenancep valueMaintenanceNo MaintenanceP value<70yo and WBC<30x109/17%20%NS22%25%NS<70 yo and WBC>30x109/l23%14%p=0.0532%23%NS>70 yo and WBC<30x109/l25%5%p=0.0125%5%p=0.008>70 yo and WBC >30x109/l2%0%NS4%0%NSOutcome of patients receiving or not maintenance therapy in 4 groups stratified according to age and WBC countIn conclusion, in patients < 70 yo consolidation ± maintenance therapy (for DFS in patients with > 30 x109/l) improves the outcome of these patients (DFS and OS). In patients > 70 yo and with WBC < 30 x109/l maintenance therapy without consolidation, improves outcome. In these later patients (> 70 yo and with WBC < 30 x 109/l) consolidation therapy decrease outcome. In patients > 70yo and with WBC > 30 x 109/l, both consolidation and/or maintenance therapy does not improve outcome.