INTENSIVE TREATMENT OF PATIENTS AGE 60 YEARS AND OLDER WITH DE-NOVO ACUTE MYELOID-LEUKEMIA - ANALYSIS OF PROGNOSTIC FACTORS

BACKGROUND. This study aimed to define pre-treatment parameters with p rognostic significance in elderly patients with de novo acute myeloid leukemia (AML) who were treated with aggressive regimens. METHODS. We analyzed, retrospectively, the clinical and laboratory features of 159 consecutive patients age >60 years with AML. Ninety-two patients pres enting as de novo AML were considered suitable for aggressive chemothe rapy according to inclusion criteria not different from those commonly used for younger adults. They belonged to all of the French-American- British classification types except M3, and their median age was 67 pe ars (range: 60-79). Antileukemic treatment consisted of 1 of 3 sequent ial protocols adopted at the S. Eugenio University Hospital of Rome be tween 1987 and 1993. The three therapeutic groups were similar in numb er and presenting characteristics. In addition to arabinosylcytosine, induction schedules included mitoxantrone (Groups I and II) or daunoru bicin (Group III), and etoposide (Groups I and III). Once in complete remission (CR), patients were consolidated with two other courses of c hemotherapy using reduced dosages of the same drugs given during induc tion. RESULTS. Induction treatment achieved a 52.2% CR rate, with medi an remission duration and event free survival (EFS) of 35 and 27 weeks , respectively. Because no significant differences between the results of the three therapeutic groups were observed, ail cases were pooled io evaluate the prognostic factors, In univariate analysis, the only p resenting characteristic significantly associated with failure of indu ction treatment was age >67 years (P = 0.007), Factors associated with an increased likelihood of shorter remission duration were CD7 expres sion on leukemic cells (P = 0.007) and an abnormal karyotype (P = 0.01 0); those predicting shorter EFS were a chromosomal status other than normal (P = 0.002) and detection of CD14 antigen (P = 0.008). Logistic regression results identified age and CD14 expression as the variable s with independent prognostic impact on CR achievement. In a stepwise proportional hazards general linear model, CD7 and karyotype retained their predictive value regarding remission duration, whereas the karyo typic pattern at diagnosis and CD14 antigen expression were the most i mportant determinants of EFS, with age showing a borderline statistica l value. A simple ''risk factor score'' was developed that would allow for stratification of patients into prognostic groups. CONCLUSIONS. C ytogenetic analysis and immunophenotyping might help to select elderly patients with AML who have little benefit from current therapeutic st rategies and with whom new approaches might be experimented. (C) 1996 American Cancer Society.