Patients older than 80 years with de novo acute myeloid leukemias without erythroblastic and/or megakaryocytic dysplasia achieve complete remission and longer survival after classical chemotherapy 3 + 7

Česká verzia

Authors: P. Lemež ^1,4; J. Gáliková ¹; K. Michalová ²; D. Dvořáková ³; A. Macwhannell ⁴; Z. Zemanová ²; J. Stejskal ³
Authors place of work: Hematologicko‑transfuzní oddělení Nemocnice Jihlava, přednostka prim. MUDr. Jiřina Gáliková ¹; Centrum nádorové cytogenetiky Ústavu klinické biochemie 1. lékařské fakulty UK a VFN Praha, vedoucí prof. Ing. Kyra Michalová, DrSc. 3Oddělení klinické a radiační onkologie Krajské nemocnice Pardubice, přednosta doc. MUDr. Jaroslav Vaňásek, CSc. ²; Department of Hematology, New Cross Hospital, Wolverhampton, England, vedoucí M. D. S. Basu, FRCPath. ⁴
Published in the journal: Vnitř Lék 2010; 56(1): 37-43
Category: Original Contributions

Summary

Chemotherapy in most patients with AML over 80 years of age is not recommended because their median survival is about 1 month. The aim of our study was to identify patients in this age group who might achieve complete remission with standard dose chemotherapy. We report 9 consecutive patients with de novo AML diagnosed and treated in 1992–2008. All bone marrow samples were hypercellular, classified as FAB types M2 in 2 cases, M4 in 6, and M5 in one case. Three patients opted for supportive or palliative therapy and survived 1–4 months. Six patients received standard dose chemotherapy. Two patients with a normal karyotype had resistant AML and survived 1.0 and 2.7 months; one patient with a complex karyotype died of septic shock on the 10th day of therapy. All these three patients exhibited erythroblastic and/or megakaryocytic dysplasia (EMD) at presentation (two in more than 26% erythroblasts, all three in a half or more of megakaryocytes). Three remaining patients with AML M4, a normal karyotype but without EMD, achieved complete remission in spite of co-morbidities and a poor performance status. Two of them survived 18.6 and 28 months on maintenance therapy, the third 16.5 months without it. Very elderly AML patients without EMD appear to represent a favorable prognostic biological category (single‑lineage AML) that show a good response to standard dose chemotherapy.

Key words:
acute myeloid leukemias – patients aged over 80 years – single‑lineage AMLs – multi‑lineage AMLs – normal karyotype – standard dose chemotherapy – dexrazoxane

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