IS THERE STILL A ROLE FOR LOW-DOSE CYTOSINE-ARABINOSIDE IN DENOVO ACUTE MYELOID-LEUKEMIA IN THE ELDERLY - A REPORT ON 77 CASES

Seventy-seven elderly patients (median age 72, range 59-85) with de no vo AML were treated with low-dose Ara C (10 mg/m2/12 h over 21 days, f or one or two courses). Thirteen (17%) achieved complete remission (CR ), 16 (21%) partial remission (PR); 28 (35%) had resistant leukemia, a nd 20 (26%) early death or death during hypoplasia. Most (86%) of the patients had severe pancytopenia and 58% were hospitalized. Overall me dian survival was 3 months. Median duration of CR was 9 months. Five C R were longer than 1 year, and two were longer than 4 years. All but o ne PR were less-than-or-equal-to 9 months, and 12/16 were less-than-or -equal-to 4 months. Karnofsky index and karyotype (the latter performe d for 52 patients) were the only significant prognostic factors of res ponse to treatment (including CR + PR) and survival: poor response rat e (8%) and survival (median 0.7 months) were found in patients with Ka rnofsky index < 60, compared with 44% and 4 months, respectively, in p atients with Karnofsky index greater-than-or-equal-to 60; likewise, pa tients with rearrangements of chromosome 5 and/or 7 or complex rearran gements had a response rate of 13% and median survival of 1.5 months, compared with 68% and 8 months, respectively, in patients with normal karyotype or single abnormalities (not involving chromosomes 5, 7, or 8). Patients with isolated trisomy 8 had a response rate of 37% but sh ort median survival (2.5 months). Significantly longer survival was se en in responders. Our findings suggest that, overall, low-dose Ara C y ields limited results in AML in the elderly. However, it could remain a useful option in elderly patients with AML who are not candidates fo r intensive chemotherapy (even with the support of growth factors), pr ovided their general condition is not too altered and they do not have an ''unfavorable'' karyotype (i.e., rearrangements of chromosomes 5 o r 7 or complex abnormalities).