979P - Expedience of maintenance treatment for patients with acute myeloid leukemia younger than 65 years according to a retrospective analysis of the eff...

Date 28 September 2014
Event ESMO 2014
Session Poster Display session
Topics Anti-Cancer Agents & Biologic Therapy
Leukaemia
Geriatric Oncology
Presenter Sergey Semochkin
Citation Annals of Oncology (2014) 25 (suppl_4): iv327-iv339. 10.1093/annonc/mdu339
Authors S. Semochkin1, T. Tolstykh2, V. Ivanova3, V. Lunin3, S. Kulikova4, N. Huazheva5, S. Chernysh3, E. Arshanskaya5, M. Pochtar5, A. Tlevtsezheva5, S. Minenko2, I. Lasarev5, O. Kudriavtseva5, L. Rybkina5, E. Tihonova5, A. Rumiantsev2
  • 1Hematology, Pirogov Russian National Research Medical University, 117997 - Moscow/RU
  • 2Adolescent And Adult Hematology, FSCC PHOI n.a. Dmitry Rogachev, Moscow/RU
  • 3Hematology, Botkin Clinical City Hospital, Moscow/RU
  • 4Hematology, Pirogov Russian National Research Medical University, Moscow/RU
  • 5Hematology, Botkin City Clinical Hospital, Moscow/RU

Abstract

Aim

Maintenance treatment is a controversial option for patients with acute myeloid leukemia (AML) in complete remission (CR). It is assumed that this approach minimizes residual disease and to prolong the duration of remission. Aims: To examine the efficacy of prolonged maintenance chemotherapy versus intensified consolidation therapy for patients with AML.

Methods

A total of 198 patients with median age 43.9 years (range, 15-64) with de novo AML which did not receive allogeneic bone marrow transplantation were enrolled in this report. Of these, 97 patients during 2000-2009 were assigned to receive 2 cycles of induction “3 + 7” (daunorubicin 45 mg/m2 on days 1-3; cytarabine 100 mg/m2 every 12 hours [q12h] on days 1-7) and consolidation of 3 cycles “1 + 5” following by maintenance chemotherapy also cycles for 2 years (trial AML-2000). Other 101 patients during 2007-2012 were treated 2 cycles of induction “3 + 7” or “3 + 7” plus HAM (cytarabine 3 g/m2 per q12h on days 1-3; mitoxantrone 10 mg/m2 on days 3-5) if the complete response (CR) was not documented after the first cycle. Then there were 4 cycles of consolidation HiDAC (3 g/m2 per q12h on days 1-3) without following maintenance (trial AML-2007).

Results

In total, 57.1% of patients achieved CR. The 5-year overall survival (OS) rate was 22.3 ± 3.3%, and the disease-free survival (DFS) rate for the 113 patients who achieved CR was 36.3 ± 5.0%. No statistical difference was observed either in the 5-year OS rate (21.5 ± 4.8% vs. 23.1 ± 4.8%; P = 0.5) or in the 5-year DFS rate (39.6 ± 7.3% vs. 49.6 ± 7.3%; P = 0.9) between the two trials. However, the incidence of late recurrence was higher for trial AML-2000 (19.6% vs. 10.9%; P = 0.047). The median length of follow-up of surviving patients was 3.3 and 9.9 years. 5-year OS rate had a negative effect of age ≥ 46 years (P = 0.004), WBC ≥ 50 000/&mgr;l (P = 0.035) and the secondary AML (P = 0.020). Intensive consolidation compared with low-intensity concolidation was accompanied by a higher frequency of adverse events III/IV degree, including neutropenia (100% vs. 68.9%; P < 0.001), thrombocytopenia (100% vs. 55.2%; P = 0.012) and enteropathy (29.4% vs. 0%; P = 0.001).

Conclusions

Maintenance treatment is an effective option for adults with AML that prolongs DFS.

Disclosure

All authors have declared no conflicts of interest.