Aggressive salvage treatment is not appropriate for the majority of elderly patients with acute myeloid leukemia relapsing after first complete remission

Background and Objectives. The prognosis of acute myeloid leukemia (AML) in the elderly is still poor because of different reasons, including a high i ncidence of relapse. The aim of this study was to investigate whether aggre ssive salvage chemotherapy (CHT) results in an actual survival advantage in elderly patients with relapsed AML, as well as to compare hospitalization and load of supportive treatment between patients receiving aggressive mana gement or only palliation. Design and Methods. One hundred and fifty consecutive patients with relapse d AML (median age 66 years) were analyzed. At relapse, 99 (66%) were treate d with CHT, and 51 had palliative management. Results. Second complete remission (CR2) was achieved in 36/99 patients (36 %) receiving CHT, while no CR was observed in the other group (p < 0.001). Induction death rate was 22%, while 41% were resistant to CHT. The median s urvival from relapse was 4 months for the whole patient population; accordi ng to management, it was 5 months and 3 months for CHT and palliation, resp ectively (p = 0.01). As to patients given CHT, a CR1 duration of more than 12 months was the only parameter significantly related to a better clinical outcome (survival from relapse: 8 vs. 4 months, p = 0.002; CR2 duration: 1 1 vs. 5 months, p = 0.001, respectively). Finally, patients managed with pa lliation required less hospitalization and less supportive therapy as compa red to the CHT group. Interpretation and Conclusions. Aggressive chemotherapy results in an actua l survival advantage only for a minority of elderly patients with relapsed AML, i.e. those with CRI lasting for more than 12 months. (C) 2001, Ferrata Storti Foundation.