Department of Hematology, Hôpital Avicenne, AP-HP, 125 Route de Stalingrad, 93000 Bobigny, France.
J Clin Oncol. 2013 Jan 20;31(3):321-7. doi: 10.1200/JCO.2011.40.3642. Epub 2012 Dec 17.
Although standard chemotherapy remains associated with a poor outcome in older patients with acute myeloid leukemia (AML), it is unclear which patients can survive long enough to be considered as cured. This study aimed to identify factors influencing the long-term outcome in these patients.
The study included 727 older patients with AML (median age, 67 years) treated in two idarubicin (IDA) versus daunorubicin (DNR) Acute Leukemia French Association trials. Prognostic analysis was based on standard univariate and multivariate models and also included a cure fraction model to focus on long-term outcome.
Age, WBC count, secondary AML, Eastern Cooperative Oncology Group (ECOG) performance status (PS), and adverse-risk and favorable-risk AML subsets (European LeukemiaNet classification) all influenced complete remission (CR) rate and overall survival (OS). IDA random assignment was associated with higher CR rate, but not with longer OS (P = .13). The overall cure rate was 13.3%. Older age and ECOG-PS more than 1 negatively influenced cure rate, which was higher in patients with favorable-risk AML (39.1% v 8.0% in adverse-risk AML; P < .001) and those treated with IDA (16.6% v 9.8% with DNR; P = .018). The long-term impact of IDA was still observed in patients younger than age 65 years, although all of the younger patients in the DNR control arm received high DNR doses (cure rate, 27.4% for IDA v 15.9% for DNR; P = .049). In multivariate analysis, IDA random assignment remained associated with a higher cure rate (P = .04), together with younger age and favorable-risk AML, despite not influencing OS (P = .11).
In older patients with AML, younger age, favorable-risk AML, and IDA treatment predict a better long-term outcome.
尽管标准化疗在老年急性髓系白血病（AML）患者中仍与不良预后相关，但尚不清楚哪些患者能够存活足够长的时间以被视为治愈。本研究旨在确定影响这些患者长期预后的因素。
该研究纳入了在两项蒽环类药物（IDA）与柔红霉素（DNR）急性白血病法国协会试验中接受治疗的 727 例老年 AML 患者（中位年龄 67 岁）。预后分析基于标准单变量和多变量模型，还包括治愈分数模型，以关注长期预后。
年龄、白细胞计数、继发性 AML、东部肿瘤协作组（ECOG）表现状态（PS）以及不良风险和有利风险 AML 亚组（欧洲白血病网分类）均影响完全缓解（CR）率和总生存（OS）。IDA 随机分组与更高的 CR 率相关，但与更长的 OS 无关（P =.13）。总体治愈率为 13.3%。年龄较大和 ECOG-PS 大于 1 均对治愈率产生负面影响，有利风险 AML 患者的治愈率较高（不良风险 AML 为 39.1%比 8.0%；P <.001），接受 IDA 治疗的患者的治愈率也较高（DNR 为 16.6%比 9.8%；P =.018）。尽管 DNR 对照组的所有年轻患者均接受了高剂量 DNR 治疗，但 IDA 的长期影响仍在年龄小于 65 岁的患者中观察到（IDA 的治愈率为 27.4%比 DNR 的 15.9%；P =.049）。在多变量分析中，IDA 随机分组与更高的治愈率相关（P =.04），同时还与年龄较小和有利风险 AML 相关，尽管不影响 OS（P =.11）。
在老年 AML 患者中，年龄较小、有利风险 AML 和 IDA 治疗预测着更好的长期预后。
