TREATMENT OF ACUTE MYELOID LEUKEMIA OF ADULTS – 5-YEARSEXPERIENCE AT UNIVERSITY CLINICAL CENTER LJUBLJANA

Abstract

BACKGROUND Over the last 30 years there has been significant improvement in survival of patients withacute myeloid leukemia (AML) under 60 years of age who have entered clinical trials. Inolder patients who have been treated with intensive chemotherapy over the same period,there was little evidence of any improvement in survival. Only minority of older patientsentered trials and presumably they were in best clinical condition that is why they formeda highly selected group. Therefore analysis of unselected older patients treated in a single center has special value. We analyzed the outcome of treatment of adult patients with AMLat the University Medical Center of Ljubljana. RESULTS A retrospective study on acute myeloid leukemia (AML) patients was carried out on 235patients treated during 5 year period. 14 patients with acute promyelocytic leukemia (APL)received tretinoin and athracycline based chemotherapy. Three of these patients died during induction period and others are still in the first remission. In the group of non-APLpatients 84 patients under age of 60 and 81 patients above 59 years of age received intensive chemotherapy. Non-intensive treatment was offered to 56 patients over the age of59. Intensive chemotherapy with DAT/DA regimens was used for treatment of youngerpatients. Beside DAT/DA regimen 36 % percent of older patients on intensive treatmentreceived ICE regimen. For younger patients the induction death rate and complete remission (CR) rates were 10 % and 70 % respectively. Among those who achieved CR, the diseasefree survival (DFS) after 4 years was 56 %. Overall survival after the same period was53 %. For older patients on intensive chemotherapy induction death and CR rates were27 % and 46 %. Overall survival and DFS after three years were 12 %. There was nodifference in treatment efficacy between DAT/DA and ICE regimen. Subgroup analysis ofolder patients failed to show any difference in survival between intensive and non-intesivetreatment. CONCLUSIONS Results of our analysis for treatment outcome of younger patients with AML are comparable to reports of acknowledged randomized trials. Patients over 59 years who had enteredclinical trials formed a highly selected group which suggests that trial data are non representative of what actually happened in older patients. A high induction death rate in ourgroup of older patients dictates the need for careful selection of older patients for intensivetherapy. Patient’s age, cytogenetics, performance status and comorbidities have to be considered