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Long-term survival can be achieved in a significant fraction of older patients with core binding factor acute myeloid leukemia treated with intensive chemotherapy.
Haematologica ( IF 8.2 ) Pub Date : 2024-10-10 , DOI: 10.3324/haematol.2024.285448
Federico Mosna,Erika Borlenghi,Mark Litzow,John C Byrd,Cristina Papayannidis,Cristina Tecchio,Felicetto Ferrara,Guido Marcucci,Roberto Cairoli,Elizabeth A Morgan,Carmela Gurrieri,Cecilia C S Yeung,H Joachim Deeg,Debora Capelli,Anna Candoni,Jason R Gotlib,Monia Lunghi,Sheeja Pullarkat,Francesco Lanza,Sara Galimberti,Fabio Forghieri,Adriano Venditti,Moreno Festuccia,Ernesta Audisio,Denise Marvalle,Gian Matteo Rigolin,Giovanni Roti,Eros DiBona,Giuseppe Visani,Francesco Albano,Ann-Kathrin Eisfeld,Peter Valent,Gerwin Huls,Gautam Borthakur,Mauro Krampera,Giovanni Martinelli,Nicolaus Kröger,Alessandra Sperotto,Michele Gottardi

Acute Myeloid Leukemia is mainly a disease of the elderly: however, the knowledge on the outcomes of treatment in core binding factor AML (CBFAML) in older population, is limited. We retrospectively collected data on 229 patients with CBF- AML followed long-term in the last two decades. A 5-year overall survival (OS) of 44.2% (95%CI, 39.9-47.5) and a 5-year event - free survival (EFS) of 32.9% (95%CI, 25.5-40.1) was observed. In a subgroup of >70-year patients who completed intensive therapy (induction + >3 courses of consolidation including autologous stem cell transplant: 10 patients) the median EFS was 11.8 months (95%CI, 9.4 - 15.2) and OS was 40.0% (95%CI, 36.4 - 44.1) at 5yr. In univariate analysis, age >70 (hazard ratio (HR) 1.78, [95%CI, 1.15 - 2.54], p=.008), failure to achieve remission following induction (HR, 8.96 [95%CI, 5.5 - 13.8], p=<.0001), no consolidation therapy (HR, 0.75 [95%CI, 0.47 - 1.84], p=.04) and less than 3 cycles of consolidation (HR, 1.48 [95%CI, 0.75 - 3.2], p=.0004), predicted poorer EFS. Our study shows that intensive therapy, in selected older CBF-AML patients, leads to longer survival. Achieving a CR seems to be the most important first step and at least 3 cycles of consolidation, an important second one. The analysis suggests that these patients should not be excluded from studies with intensive therapies.

中文翻译:


在接受强化化疗的核心结合因子急性髓性白血病老年患者中,很大一部分可以实现长期生存。



急性髓性白血病主要是一种老年人疾病:然而,关于老年人核心结合因子 AML (CBFAML) 治疗结果的了解有限。我们回顾性收集了过去二十年中长期随访的 229 例 CBF-AML 患者的数据。观察到 5 年总生存率 (OS) 为 44.2% (95% CI,39.9-47.5) 和 5 年事件自由生存率 (EFS) 为 32.9% (95%CI,25.5-40.1)。在完成强化治疗 (诱导 + >3 巩固治疗,包括自体干细胞移植:10 名患者) 的 >70 患者亚组中,中位 EFS 为 11.8 个月 (95%CI,9.4 - 15.2),OS 为 40.0% (95% CI,36.4 - 44.1) 5 年。在单变量分析中,年龄 >70 (风险比 (HR) 1.78,[95%CI,1.15 - 2.54],p=.008),诱导后未能达到缓解 (HR,8.96 [95%CI,5.5 - 13.8],p=<.0001),无巩固治疗 (HR,0.75 [95%CI,0.47 - 1.84],p=.04) 和少于 3 个巩固周期 (HR,1.48 [95%CI,0.75 - 3.2],p=.0004),预测较差的 EFS。我们的研究表明,在选定的老年 CBF-AML 患者中,强化治疗可延长生存期。实现 CR 似乎是最重要的第一步,也是至少 3 个巩固周期,即重要的第二个周期。分析表明,这些患者不应被排除在强化治疗研究之外。
更新日期:2024-10-10
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