Azacitidine improves clinical outcomes in older patients with acute myeloid leukaemia with myelodysplasia-related changes compared with conventional care regimensopen access
- Authors
- Seymour, JF[Seymour, John F.]; Dohner, H[Doehner, Hartmut]; Butrym, A[Butrym, Aleksandra]; Wierzbowska, A[Wierzbowska, Agnieszka]; Selleslag, D[Selleslag, Dominik]; Jang, JH[Jang, Jun Ho]; Kumar, R[Kumar, Rajat]; Cavenagh, J[Cavenagh, James]; Schuh, AC[Schuh, Andre C.]; Candoni, A[Candoni, Anna]; Recher, C[Recher, Christian]; Sandhu, I[Sandhu, Irwindeep]; del Castillo, TB[del Castillo, Teresa Bernal]; Al-Ali, HK[Al-Ali, Haifa Kathrin]; Falantes, J[Falantes, Jose]; Stone, RM[Stone, Richard M.]; Minden, MD[Minden, Mark D.]; Weaver, J[Weaver, Jerry]; Songer, S[Songer, Steve]; Beach, CL[Beach, C. L.]; Dombret, H[Dombret, Herve]
- Issue Date
- 14-Dec-2017
- Publisher
- BIOMED CENTRAL LTD
- Keywords
- Azacitidine; Low-dose cytarabine; Acute myeloid leukaemia; AML; Myelodysplasia-related changes; AML-MRC; Induction chemotherapy; Response; Survival
- Citation
- BMC CANCER, v.17
- Indexed
- SCIE
SCOPUS
- Journal Title
- BMC CANCER
- Volume
- 17
- URI
- https://scholarworks.bwise.kr/skku/handle/2021.sw.skku/26053
- DOI
- 10.1186/s12885-017-3803-6
- ISSN
- 1471-2407
- Abstract
- Background: Compared with World Health Organization-defined acute myeloid leukaemia (AML) not otherwise specified, patients with AML with myelodysplasia-related changes (AML-MRC) are generally older and more likely to have poor-risk cytogenetics, leading to poor response and prognosis. More than one-half of all older (>= 65 years) patients in the phase 3 AZA-AML-001 trial had newly diagnosed AML-MRC. Methods: We compared clinical outcomes for patients with AML-MRC treated with azacitidine or conventional care regimens (CCR; induction chemotherapy, low-dose cytarabine, or supportive care only) overall and within patient subgroups defined by cytogenetic risk (intermediate or poor) and age (65-74 years or >= 75 years). The same analyses were used to compare azacitidine with low-dose cytarabine in patients who had been preselected to low-dose cytarabine before they were randomized to receive azacitidine or CCR (ie, low-dose cytarabine). Results: Median overall survival was significantly prolonged with azacitidine (n = 129) versus CCR (n = 133): 8.9 versus 4.9 months (hazard ratio 0.74, [95% CI 0.57, 0.97]). Among patients with intermediate-risk cytogenetics, median overall survival with azacitidine was 16.4 months, and with CCR was 8.9 months (hazard ratio 0.73 [95% CI 0.48, 1.10]). Median overall survival was significantly improved for patients ages 65-74 years treated with azacitidine compared with those who received CCR (14.2 versus 7.3 months, respectively; hazard ratio 0.64 [95% CI 0.42, 0.97]). Within the subgroup of patients preselected to low-dose cytarabine before randomization, median overall survival with azacitidine was 9.5 months versus 4.6 months with low-dose cytarabine (hazard ratio 0.77 [95% CI 0.55, 1.09]). Within the low-dose cytarabine preselection group, patients with intermediate-risk cytogenetics who received azacitidine had a median overall survival of 14.1 months versus 6.4 months with low-dose cytarabine, and patients aged 65-74 years had median survival of 14.9 months versus 5.2 months, respectively. Overall response rates were similar with azacitidine and CCR (24.8% and 17.3%, respectively), but higher with azacitidine versus low-dose cytarabine (27.2% and 13.9%). Adverse events were generally comparable between the treatment arms. Conclusions: Azacitidine may be the preferred treatment for patients with AML-MRC who are not candidates for intensive chemotherapy, particularly patients ages 65-74 years and those with intermediate-risk cytogenetics.
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Collections - Medicine > Department of Medicine > 1. Journal Articles
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