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Azacitidine might be beneficial in a subgroup of older AML patients compared to intensive chemotherapy: a single centre retrospective study of 227 consecutive patients

Lieke H van der Helm1, Ellen RM Scheepers1, Nic JGM Veeger1, Simon MGJ Daenen1, André B Mulder2, Eva van den Berg3, Edo Vellenga1* and Gerwin Huls1

Author Affiliations

1 Department of Haematology, University Medical Centre Groningen, University of Groningen, Hanzeplein 1, Groningen, 9713 GZ, The Netherlands

2 Department of Laboratory Medicine, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands

3 Department of Genetics, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands

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Journal of Hematology & Oncology 2013, 6:29  doi:10.1186/1756-8722-6-29

Published: 16 April 2013

Abstract

Background

Treatment options in older acute myeloid leukaemia (AML) patients include intensive chemotherapy, best supportive care (BSC), and hypomethylating agents. Currently, limited data is available on hypomethylating agents in older AML patients in unselected patient populations.

Methods

To compare the effectiveness of azacitidine with conventional therapy, we collected data of 227 consecutive AML patients (≥60 years) who were treated with azacitidine (N = 26), intensive chemotherapy (N = 90), or BSC (N = 97).

Results

Azacitidine-treated patients were older and had more comorbidities, but lower white blood cell- and bone marrow blast counts compared with intensive chemotherapy patients. Complete or partial response was achieved in 42% of azacitidine-treated patients and in 73% of intensive chemotherapy patients (P = 0.005). However, the overall survival (OS) was similar (1-year-OS 57% versus 56%, P = 0.93; 2-year-OS 35% versus 35%, P = 0.92), and remained similar after correction for risk factors in a multivariate analysis. Patients treated with BSC had an inferior OS (1-year- and 2-year-OS 16% and 2%, P < 0.001). Compared to intensive chemotherapy, azacitidine-treated patients spent less days in the hospital (median in first three months 0.5 versus 56, P < 0.001), and needed less red blood cell and platelet transfusions (median per month 2.7 versus 7, P < 0.001 and 0.3 versus 5, P < 0.001) in the first three months.

Conclusions

Azacitidine treatment is associated with a comparable OS but higher tolerability in a subgroup of older AML patients compared with intensive chemotherapy. Patients receiving BSC had a poor prognosis.

Keywords:
Acute myeloid leukaemia; Older age; Azacitidine; Intensive chemotherapy; Best supportive care