The Role of Azacitidine in the Treatment of Elderly Patients with Acute Myeloid Leukemia:  Results of a Retrospective Multicenter Study

The Role of Azacitidine in the Treatment of Elderly Patients with Acute Myeloid Leukemia: Results of a Retrospective Multicenter Study [Turk J Hematol]

Turk J Hematol. 2016; 33(4): 273-280 | DOI: 10.4274/tjh.2015.0203

The Role of Azacitidine in the Treatment of Elderly Patients with Acute Myeloid Leukemia: Results of a Retrospective Multicenter Study

An�l Tombak¹, Mehmet Ali U�ar¹, Aydan Akdeniz¹, Ey�p Naci Tiftik¹, Deniz G�ren �ahin², Olga Meltem Akay², Murat Y�ld�r�m³, Oral Nevruz³, Cem Kis⁴, Emel G�rkan⁴, �erife Medeni Solmaz⁵, Mehmet Ali �zcan⁵, Rah�an Y�ld�r�m⁶, �lhami Berber⁷, Mehmet Ali Erkurt⁷, T�lin F�ratl� Tu�lular⁸, P�nar Tarkun⁹, �rfan Yava�o�lu¹⁰, Mehmet Hilmi Do�u¹¹, �smail Sar�¹¹, Mustafa Merter¹², Muhit �zcan¹², Esra Y�ld�zhan¹³, Leylag�l Kaynar¹³, �zg�r Mehtap⁹, Ay�e Uysal¹⁴, Fahri �ahin¹⁴, Ozan Salim¹⁵, Mehmet Ali Sungur¹⁶
¹Mersin University Faculty of Medicine, Department of Hematology, Mersin, Turkey
²Osmangazi University Faculty of Medicine, Department of Hematology, Eski�ehir, Turkey
³G�lhane Training and Research Hospital, Clinic of Hematology, Ankara, Turkey
⁴�ukurova University Faculty of Medicine, Department of Hematology, Adana, Turkey
⁵Dokuz Eyl�l University Faculty of Medicine, Department of Hematology, �zmir, Turkey
⁶Atat�rk University Faculty of Medicine, Department of Hematology, Erzurum, Turkey
⁷�n�n� University Faculty of Medicine, Department of Hematology, Malatya, Turkey
⁸Marmara University Faculty of Medicine, Department of Hematology, �stanbul, Turkey
⁹Kocaeli University Faculty of Medicine, Department of Hematology, Kocaeli, Turkey
¹⁰Adnan Menderes University Faculty of Medicine, Department of Hematology, Ayd�n, Turkey
¹¹Pamukkale University Faculty of Medicine, Department of Hematology, Denizli, Turkey
¹²Ankara University Faculty of Medicine, Department of Hematology, Ankara, Turkey
¹³Erciyes University Faculty of Medicine, Department of Hematology, Kayseri, Turkey
¹⁴Ege University Faculty of Medicine, Department of Hematology, �zmir, Turkey
¹⁵Akdeniz University Faculty of Medicine, Department of Hematology, Antalya, Turkey
¹⁶D�zce University Faculty of Medicine, Department of Biostatistics, D�zce, Turkey

Objective: In this study, we aimed to investigate the efficacy and safety of azacitidine (AZA) in elderly patients with acute myeloid leukemia (AML), including patients with >30% bone marrow (BM) blasts.
Materials and Methods: In this retrospective multicenter study, 130 patients of ≥60 years old who were ineligible for intensive chemotherapy or had progressed despite conventional treatment were included.
Results: The median age was 73 years and 61.5% of patients had >30% BM blasts. Patients received AZA for a median of four cycles (range: 1-21). Initial overall response [including complete remission (CR)/CR with incomplete recovery/partial remission] was 36.2%.
Hematologic improvement (HI) of any kind was documented in 37.7% of all patients. HI was also documented in 27.1% of patients who were unresponsive to treatment.nMedian overall survival (OS) was 18 months for responders and 12 months for nonresponders (p=0.005). In the unresponsive patient group, any HI improved OS compared to patients without any HI (median OS was 14 months versus 10 months, p=0.068). Eastern Cooperative Oncology Group performance status of <2, increasing number of AZA cycles (≥5 courses), and any HI predicted better OS. Age, AML type, and BM blast percentage had no impact.
Conclusion: We conclude that AZA is effective and well tolerated in elderly comorbid AML patients, irrespective of BM blast count, and HI should be considered a sufficient response to continue treatment with AZA.

Keywords: Azacitidine, Acute myeloid leukemia, Elderly, Bone marrow blasts, Prognostic factors, Overall survival

Akut Miyeloid L�semili Ya�l� Hastalar�n Tedavisinde Azasitidinin Rol�: Retrospektif �ok Merkezli Bir �al��man�n Sonu�lar�

Ama�: Bu �al��mada, kemik ili�indeki (K�) blast oran� >%30 olan olgular� da i�eren akut miyeloid l�semili (AML) ya�l� hastalarda, azasitidinin (AZA) etkinli�inin ve g�venli�inin ara�t�r�lmas�n� ama�lad�k.
Gere� ve Y�ntem: Bu geriye d�n�k, �ok merkezli �al��maya, yo�un kemoterapi i�in uygun olmayan ya da konvansiyonel tedavilere ra�men hastal�� ilerleyen ≥60 ya�taki 130 hasta dahil edildi.
Bulgular: Ortanca ya� 73 idi, hastalar�n %61,5�inde K� blast oran� >%30 olarak bulundu. Hastalar, ortanca 4 d�ng� (1-21 aral��nda) AZA alm��t�. Ba�lang�� genel yan�t oran� [tam yan�t� (TY)/eksik d�zelmenin oldu�u TY/k�smi yan�t� i�eren] %36,2 idi. Herhangi bir hematolojik d�zelme (HD), t�m hastalar�n %36,2�sinde tespit edildi. HD tedaviye yan�ts�z hastalar�n %27,1�inde de saptand�. Ortanca genel sa�kal�m, yan�t verenlerde 18 ay, yan�t vermeyenlerde 12 ay idi (p=0,005). Tedaviye yan�ts�z hasta grubunda HD�nin, HD olmayanlara k�yasla genel sa�kal�m� artt�rd�� g�r�ld� (ortanca sa�kal�m 14 aya k�yasla 10 ay, p=0,068). Do�u Kooperatif Onkoloji Grubu performans durumunun <2 olmas�, AZA d�ng� say�s�n�n artmas� (≥5 d�ng�) ve herhangi bir HD olmas�, daha iyi genel sa�kal�m� �ng�r�yordu. Ya��n, AML tipinin, K� blast y�zdesinin etkisi yoktu.
Sonu�: AZA, ya�l�, e�lik eden hastal�klar� olan AML�li hastalarda, K� blast say�s�ndan ba��ms�z olarak etkindir ve iyi tolere edilmektedir ve HD�nin, AZA ile tedaviye devam etmek i�in yeterli bir yan�t oldu�u g�z �n�nde bulundurulmal�d�r.

Anahtar Kelimeler: Azasitidin, Akut miyeloid l�semi, Ya�l�, Kemik ili�i blastlar�, Prognostik fakt�rler, Genel sa�kal�m

An�l Tombak, Mehmet Ali U�ar, Aydan Akdeniz, Ey�p Naci Tiftik, Deniz G�ren �ahin, Olga Meltem Akay, Murat Y�ld�r�m, Oral Nevruz, Cem Kis, Emel G�rkan, �erife Medeni Solmaz, Mehmet Ali �zcan, Rah�an Y�ld�r�m, �lhami Berber, Mehmet Ali Erkurt, T�lin F�ratl� Tu�lular, P�nar Tarkun, �rfan Yava�o�lu, Mehmet Hilmi Do�u, �smail Sar�, Mustafa Merter, Muhit �zcan, Esra Y�ld�zhan, Leylag�l Kaynar, �zg�r Mehtap, Ay�e Uysal, Fahri �ahin, Ozan Salim, Mehmet Ali Sungur. The Role of Azacitidine in the Treatment of Elderly Patients with Acute Myeloid Leukemia: Results of a Retrospective Multicenter Study. Turk J Hematol. 2016; 33(4): 273-280

Corresponding Author: An�l Tombak, T�rkiye

TOOLS

Full Text PDF

Download citation

RIS

EndNote

BibTex

Medlars

Procite

Reference Manager

Share with email

Send email to author

Similar articles

PubMed

Google Scholar

In authors and institutes In titles and abstracts In keywords In all


	E-ISSN: 1308-5263
Archive Most Accessed Articles Most Cited Articles Aims and Scope Instructions For Authors Editorial Board Advisory Board Manuscript Submission Why to Submit Search Contact