O1-1-4 - Prognostic Factors of Elderly Patients with Acute Myeloid Leukemia: a Retrospective Multi-Center Study on 101 Patients

Abstract

Background: The incidence of acute myeloid leukemia (AML) is increasing substantially for individuals 65 years of age or older. However, no optimal treatment for elderly patients with AML has been established. The purpose of this study was to assess outcome of elderly patients with AML and prognostic factors.Patients and methods: We retrospectively analyzed 101 AML patients more than 65 years who were newly diagnosed at Tsukuba University Hospital and Hitachi general hospital from 2008 to 2013. The median age was 74 (65 - 88). Diagnosis included AML, NOS (n = 47), AML/MRC (n = 46), therapy-related AML (n = 2), AML with t(8;21) (n = 5), AML with inv(16) (n = 1). Karyotypes according to IPSS were good (n= 6), intermediate (n = 58), and poor (n = 37).Results: Intensive remission induction therapy was performed in 37 (33.9%), a less intense chemotherapy such as low-dose cytarabine was performed in 39 (35.7%) and 5-azacitidine (5-Aza) as remission induction was performed in 6 (5.5%). Complete remission (CR) was achieved in 39.2% of all treated patients and the estimated 2-year survival was 23.4%. The median duration of overall survival (OS) was 11 months. In univariate analyses, to perform induction therapy, CR and usage of 5-Aza were found to be associated with good prognosis, on the other hand, poor karyotype significantly shorten the survival. The age, gender, prior to MDS were not significantly related to outcomes. In a multivariate analysis, CR (hazard ratio (HR), 0.1067; 95% confidence interval(CI), 0.05-0.22; p < 0.01), 5-Aza (HR, 0.24; 95% CI, 0.11-0.49; p < 0.01) and poor karyotype (HR, 1.85; 95% CI, 1.13-3.04; p = 0.01) were also significant.Conclusions: This retrospective cohort analysis suggests that 5-Aza should be considered as a treatment option in elderly patients with AML.