학술논문
Cladribine Combined with Low-Dose Cytarabine as Frontline Treatment for Unfit Elderly Acute Myeloid Leukemia Patients: Results from a Prospective Multicenter Study of Polish Adult Leukemia Group (PALG)
Document Type
article
Author
Bożena Katarzyna Budziszewska; Aleksander Salomon-Perzyński; Katarzyna Pruszczyk; Joanna Barankiewicz; Agnieszka Pluta; Grzegorz Helbig; Anna Janowska; Marta Kuydowicz; Łukasz Bołkun; Jarosław Piszcz; Elżbieta Patkowska; Marzena Wątek; Piotr Małecki; Sylwia Kościołek-Zgódka; Edyta Cichocka; Grzegorz Charliński; Anna Irga-Staniukiewicz; Jan Maciej Zaucha; Agnieszka Piekarska; Tomasz Gromek; Marek Hus; Karol Wójcik; Małgorzata Raźny; Mariola Sędzimirska; Bartosz Puła; Sebastian Giebel; Sebastian Grosicki; Agnieszka Wierzbowska; Ewa Lech-Marańda
Source
Cancers, Vol 13, Iss 16, p 4189 (2021)
Subject
Language
English
ISSN
2072-6694
Abstract
Acute myeloid leukemia (AML) in older unfit patients is a therapeutic challenge for clinical hematologists. We evaluated the efficacy and safety of a novel low-intensity regimen consisting of low-dose cytarabine and cladribine (LD-AC+cladribine) in first-line treatment of elderly (≥60 years) AML patients not eligible for intensive chemotherapy (IC) who had either the Eastern Cooperative Oncology Group performance status (ECOG PS) ≥2 or the hematopoietic cell transplantation comorbidity index (HCT-CI) score ≥3. The induction phase included two cycles of LD-AC+cladribine. Patients who achieved at least partial remission (PR) received maintenance treatment with LD-AC alone. Overall, 117 patients with a median age of 70 years were enrolled. Adverse cytogenetics, ECOG PS ≥2 and HCT-CI score ≥3 was observed in 43.5%, 60%, and 58% of patients, respectively. The response rate (≥PR) was 54% (complete remission [CR], 32%; CR with incomplete hematologic recovery [CRi], 5%). A median overall survival (OS) was 21 and 8.8 months in CR/CRi and PR group, respectively. Advanced age (≥75 years) and adverse cytogenetics had a negative impact on OS. The 56-day mortality rate was 20.5%. In conclusion, LD-AC+cladribine is a beneficial therapeutic option with a predictable safety profile in elderly AML patients not eligible for IC.