Senapati Jayastu, Kantarjian Hagop M, Kadia Tapan M, Kekedjian Jeannot, Borthakur Gautam, Daver Naval, DiNardo Courtney D, Jabbour Elias, Bose Prithviraj, Short Nicholas J, Yilmaz Musa, Jain Nitin, Pemmaraju Naveen, Abbas Hussein A, Issa Ghayas C, Maiti Abhishek, Bravo Guillermo Montalban, Deshmukh Indraneel, Shpall Elizabeth, Kebriaei Partow, Popat Uday, Loghavi Sanam, Thakral Beenu, Tang Guilin, Haddad Fadi G, Alvarado Yesid, Manero Guillermo Garcia, Ravandi Farhad
Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Cancer. 2025 Aug 15;131(16):e70028. doi: 10.1002/cncr.70028.
Octa-nonagenarians with acute myeloid leukemia (AML) represent a high-risk group due to frequently poor performance status, adverse genomics (e.g., TP53 mutations, complex karyotype), a high incidence of secondary AML, and inability to undergo an allogeneic stem cell transplantation. Evaluating their outcomes with modern treatment approaches is important.
This retrospective study analyzed outcomes of patients ≥80 years old with newly diagnosed AML treated at our center from 2013-2023.
A total of 289 patients (median age, 83 years; range, 80-95 years) were included. Venetoclax containing low-intensity therapy was administered to 107 patients (37.0%). AML subtypes included de novo (123, 42.6%), secondary (114, 39.4% [82 treated-secondary, 32 untreated-secondary]), therapy-related without prior myeloid neoplasm (40, 13.8%), and post-myeloproliferative neoplasm AML (12, 4.3%). Composite complete response (CRc) was achieved in 43.2%, with higher rates in venetoclax-treated patients (61.7% vs. 32.4%, p < .001). Median relapse-free survival among patients with a CRc was 6.5 months. Median overall survival (OS) was 6.2 months; 13.7 months for those achieving CRc. One-year nonrelapse mortality was 18.4%. Median OS was 7.7 months with venetoclax versus 5.4 months without. In de novo AML, median OS with venetoclax was 11.1 months. Among venetoclax-treated patients, favorable subgroups (e.g., NPM1 and/or IDH1/2 mutations and/or myelodysplasia related mutations without TP53 mutation and adverse cytogenetics) achieved OS up to 16.0-16.3 months. On multivariate analysis, de novo AML, wild-type TP53, and venetoclax therapy were independently associated with improved OS.
Low-intensity venetoclax-based regimens offer meaningful survival benefits in selected octa-nonagenarian patients with AML, particularly those with favorable genomic profiles.
患有急性髓系白血病（AML）的八九十岁老人由于身体状况通常较差、基因组学不良（如TP53突变、复杂核型）、继发性AML发病率高以及无法进行异基因干细胞移植，属于高危群体。评估他们采用现代治疗方法的治疗结果很重要。
这项回顾性研究分析了2013年至2023年在我们中心接受治疗的≥80岁新诊断AML患者的治疗结果。
共纳入289例患者（中位年龄83岁；范围80 - 95岁）。107例患者（37.0%）接受了含维奈克拉的低强度治疗。AML亚型包括初发（123例，42.6%）、继发（114例，39.4%[82例经治疗的继发、32例未经治疗的继发]）、无既往髓系肿瘤的治疗相关型（40例，13.8%）以及骨髓增殖性肿瘤后AML（12例，4.3%）。复合完全缓解（CRc）率为43.2%，维奈克拉治疗的患者中该率更高（61.7%对32.4%，p <.001）。CRc患者的中位无复发生存期为6.5个月。中位总生存期（OS）为6.2个月；达到CRc的患者为13.7个月。1年无复发死亡率为18.4%。使用维奈克拉的患者中位OS为7.7个月，未使用者为5.4个月。在初发AML中，使用维奈克拉的患者中位OS为11.1个月。在维奈克拉治疗的患者中，有利亚组（如NPM1和/或IDH1/2突变和/或与骨髓增生异常相关的突变且无TP53突变和不良细胞遗传学特征）的OS可达16.0 - 16.3个月。多因素分析显示，初发AML、野生型TP53和维奈克拉治疗与OS改善独立相关。
基于维奈克拉的低强度方案为部分患有AML的八九十岁老人带来了显著的生存益处，尤其是那些具有有利基因组特征的患者。
