The Role of Azacitidine in the Treatment of Elderly Patients with Acute Myeloid Leukemia: Results of a Retrospective Multicenter Study [Turk J Hematol]
Turk J Hematol. 2016; 33(4): 273-280 | DOI: 10.4274/tjh.2015.0203  

The Role of Azacitidine in the Treatment of Elderly Patients with Acute Myeloid Leukemia: Results of a Retrospective Multicenter Study

Anıl Tombak1, Mehmet Ali Uçar1, Aydan Akdeniz1, Eyüp Naci Tiftik1, Deniz Gören Şahin2, Olga Meltem Akay2, Murat Yıldırım3, Oral Nevruz3, Cem Kış4, Emel Gürkan4, Şerife Medeni Solmaz5, Mehmet Ali Özcan5, Rahşan Yıldırım6, İlhami Berber7, Mehmet Ali Erkurt7, Tülin Fıratlı Tuğlular8, Pınar Tarkun9, İrfan Yavaşoğlu10, Mehmet Hilmi Doğu11, Et Al
1Mersin University Faculty of Medicine, Department of Hematology, Mersin, Turkey
2Osmangazi University Faculty of Medicine, Department of Hematology, Eskişehir, Turkey
3Gülhane Training and Research Hospital, Clinic of Hematology, Ankara, Turkey
4Çukurova University Faculty of Medicine, Department of Hematology, Adana, Turkey
5Dokuz Eylül University Faculty of Medicine, Department of Hematology, İzmir, Turkey
6Atatürk University Faculty of Medicine, Department of Hematology, Erzurum, Turkey
7İnönü University Faculty of Medicine, Department of Hematology, Malatya, Turkey
8Marmara University Faculty of Medicine, Department of Hematology, İstanbul, Turkey
9Kocaeli University Faculty of Medicine, Department of Hematology, Kocaeli, Turkey
10Adnan Menderes University Faculty of Medicine, Department of Hematology, Aydın, Turkey
11Pamukkale University Faculty of Medicine, Department of Hematology, Denizli, Turkey

Objective: In this study, we aimed to investigate the efficacy and safety of azacitidine (AZA) in elderly patients with acute myeloid leukemia (AML), including patients with >30% bone marrow (BM) blasts.
Materials and Methods: In this retrospective multicenter study, 130 patients of ≥60 years old who were ineligible for intensive chemotherapy or had progressed despite conventional treatment were included.
Results: The median age was 73 years and 61.5% of patients had >30% BM blasts. Patients received AZA for a median of four cycles (range: 1-21). Initial overall response [including complete remission (CR)/CR with incomplete recovery/partial remission] was 36.2%.
Hematologic improvement (HI) of any kind was documented in 37.7% of all patients. HI was also documented in 27.1% of patients who were unresponsive to treatment.nMedian overall survival (OS) was 18 months for responders and 12 months for nonresponders (p=0.005). In the unresponsive patient group, any HI improved OS compared to patients without any HI (median OS was 14 months versus 10 months, p=0.068). Eastern Cooperative Oncology Group performance status of <2, increasing number of AZA cycles (≥5 courses), and any HI predicted better OS. Age, AML type, and BM blast percentage had no impact.
Conclusion: We conclude that AZA is effective and well tolerated in elderly comorbid AML patients, irrespective of BM blast count, and HI should be considered a sufficient response to continue treatment with AZA.

Keywords: Azacitidine, Acute myeloid leukemia, Elderly, Bone marrow blasts, Prognostic factors, Overall survival


Akut Miyeloid Lösemili Yaşlı Hastaların Tedavisinde Azasitidinin Rolü: Retrospektif Çok Merkezli Bir Çalışmanın Sonuçları

Anıl Tombak1, Mehmet Ali Uçar1, Aydan Akdeniz1, Eyüp Naci Tiftik1, Deniz Gören Şahin2, Olga Meltem Akay2, Murat Yıldırım3, Oral Nevruz3, Cem Kış4, Emel Gürkan4, Şerife Medeni Solmaz5, Mehmet Ali Özcan5, Rahşan Yıldırım6, İlhami Berber7, Mehmet Ali Erkurt7, Tülin Fıratlı Tuğlular8, Pınar Tarkun9, İrfan Yavaşoğlu10, Mehmet Hilmi Doğu11, Et Al
1Mersin University Faculty of Medicine, Department of Hematology, Mersin, Turkey
2Osmangazi University Faculty of Medicine, Department of Hematology, Eskişehir, Turkey
3Gülhane Training and Research Hospital, Clinic of Hematology, Ankara, Turkey
4Çukurova University Faculty of Medicine, Department of Hematology, Adana, Turkey
5Dokuz Eylül University Faculty of Medicine, Department of Hematology, İzmir, Turkey
6Atatürk University Faculty of Medicine, Department of Hematology, Erzurum, Turkey
7İnönü University Faculty of Medicine, Department of Hematology, Malatya, Turkey
8Marmara University Faculty of Medicine, Department of Hematology, İstanbul, Turkey
9Kocaeli University Faculty of Medicine, Department of Hematology, Kocaeli, Turkey
10Adnan Menderes University Faculty of Medicine, Department of Hematology, Aydın, Turkey
11Pamukkale University Faculty of Medicine, Department of Hematology, Denizli, Turkey

Amaç: Bu çalışmada, kemik iliğindeki (Kİ) blast oranı >%30 olan olguları da içeren akut miyeloid lösemili (AML) yaşlı hastalarda, azasitidinin (AZA) etkinliğinin ve güvenliğinin araştırılmasını amaçladık.
Gereç ve Yöntem: Bu geriye dönük, çok merkezli çalışmaya, yoğun kemoterapi için uygun olmayan ya da konvansiyonel tedavilere rağmen hastalığı ilerleyen ≥60 yaştaki 130 hasta dahil edildi.
Bulgular: Ortanca yaş 73 idi, hastaların %61,5’inde Kİ blast oranı >%30 olarak bulundu. Hastalar, ortanca 4 döngü (1-21 aralığında) AZA almıştı. Başlangıç genel yanıt oranı [tam yanıtı (TY)/eksik düzelmenin olduğu TY/kısmi yanıtı içeren] %36,2 idi. Herhangi bir hematolojik düzelme (HD), tüm hastaların %36,2’sinde tespit edildi. HD tedaviye yanıtsız hastaların %27,1’inde de saptandı. Ortanca genel sağkalım, yanıt verenlerde 18 ay, yanıt vermeyenlerde 12 ay idi (p=0,005). Tedaviye yanıtsız hasta grubunda HD’nin, HD olmayanlara kıyasla genel sağkalımı arttırdığı görüldü (ortanca sağkalım 14 aya kıyasla 10 ay, p=0,068). Doğu Kooperatif Onkoloji Grubu performans durumunun <2 olması, AZA döngü sayısının artması (≥5 döngü) ve herhangi bir HD olması, daha iyi genel sağkalımı öngörüyordu. Yaşın, AML tipinin, Kİ blast yüzdesinin etkisi yoktu.
Sonuç: AZA, yaşlı, eşlik eden hastalıkları olan AML’li hastalarda, Kİ blast sayısından bağımsız olarak etkindir ve iyi tolere edilmektedir ve HD’nin, AZA ile tedaviye devam etmek için yeterli bir yanıt olduğu göz önünde bulundurulmalıdır.

Anahtar Kelimeler: Azasitidin, Akut miyeloid lösemi, Yaşlı, Kemik iliği blastları, Prognostik faktörler, Genel sağkalım


Anıl Tombak, Mehmet Ali Uçar, Aydan Akdeniz, Eyüp Naci Tiftik, Deniz Gören Şahin, Olga Meltem Akay, Murat Yıldırım, Oral Nevruz, Cem Kış, Emel Gürkan, Şerife Medeni Solmaz, Mehmet Ali Özcan, Rahşan Yıldırım, İlhami Berber, Mehmet Ali Erkurt, Tülin Fıratlı Tuğlular, Pınar Tarkun, İrfan Yavaşoğlu, Mehmet Hilmi Doğu, Et Al. The Role of Azacitidine in the Treatment of Elderly Patients with Acute Myeloid Leukemia: Results of a Retrospective Multicenter Study. Turk J Hematol. 2016; 33(4): 273-280

Corresponding Author: Anıl Tombak, Türkiye


TOOLS
Full Text PDF
Print
Download citation
RIS
EndNote
BibTex
Medlars
Procite
Reference Manager
Share with email
Share
Send email to author

Similar articles
PubMed
Google Scholar


 



Impact Factor (2015) = 0.827