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The outcome of intensive induction therapy in patients ⩾70 years with acute myeloid leukemia

Leukemia volume 21, pages 1321–1324 (2007)Cite this article

There continues to be controversy about the suitable upper age for intensive induction therapy in older patients with acute myeloid leukemia (AML). Some investigators have reported increasing age as a poor prognostic factor for complete remission (CR) and survival in older patients with AML,1, 2 whereas others did not observe an adverse impact of age.3, 4, 5, 6 A recent study from the German–Austrian AML study group showed that patients ⩾70 years had poor survival irrespective of cytogenetics risk group.7 These data question the utility of intensive therapy in patients ⩾70 years.

In view of the above controversy, we evaluated the outcomes of AML patients ⩾70 years (acute promyelocytic leukemia excluded) treated with intensive therapy at our institute as compared with those aged 60–69 years. Between 1998 and 2005, we treated 291 newly diagnosed patients ⩾60 years (median age 68 years) with intensive therapy. This study includes 117 patients ⩾60 years with previously reported outcomes.6 Candidacy for induction therapy was decided on the basis of general fitness, adequate left ventricular ejection fraction (⩾50%) and patients' wishes to proceed with induction therapy. Of particular note, 264 patients (91%) received uniform induction therapy consisting of daunorubicin 60 mg/m2/day × 3 days and cytarabine 100 mg/m2/day × 7 days as described previously.6 In a minority of patients (n=27), chemotherapy was modified owing to significant organ dysfunction according to the discretion of the treating physician. Those who did not achieve CR with one course were given a second course with mitoxantrone, etoposide and cytarabine as described previously.6 For patients achieving CR, two courses of post-remission therapy were given. Before 2002, post-remission therapy was with daunorubicin and modified course of high-dose cytarabine as previously described.6 From 2003 to 2005, first course of post-remission therapy was daunorubicin and cytarabine identical to the induction therapy and second course was with mitoxantrone (10 mg/m2/day × 5 days, days 1–5) and etoposide (100 mg/m2/day × 5 days, days 1–5). No differences in outcomes according to post-remission therapy strategy were seen (data not shown).

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Authors and Affiliations

  1. Department of Medical Oncology and Hematology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada

    V Gupta, C Keng, J Brandwein, A Schimmer, A Schuh, K Yee & M D Minden

  2. Department of Biostatistics, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada

    W Xu

  3. Department of Medicine, University Health Network, Toronto, Ontario, Canada

    S M H Alibhai

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  1. V Gupta
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  2. W Xu
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Correspondence to V Gupta.

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Gupta, V., Xu, W., Keng, C. et al. The outcome of intensive induction therapy in patients ⩾70 years with acute myeloid leukemia. Leukemia 21, 1321–1324 (2007). https://doi.org/10.1038/sj.leu.2404655

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