JOMPAC
Journal of Medicine and Palliative Care

Journal of Medicine and Palliative Care (JOMPAC) is an open access scientific journal with independent, unbiased, and double-blind review under international guidelines. The purpose of JOMPAC is to contribute to the literature by publishing articles on health sciences and medicine.

eISSN: 2717-7505
Creative Commons CC BY-NC-ND 4.0 International License.
EndNote Style

Submit Manuscript

Index
Original Article
Comparison of low dose cytosine arabinoside, azacitidine and azacitidine venetoclax combination treatment as remission induction in elderly acute myeloid leukemia patients
Abstract
Aims: Low-intensity therapies are widely preferred in the treatment of advanced age, fragile acute myeloid leukemia (AML) patients. In this study, we aimed to compare hematological recovery rates after first cycle chemotherapy and overall survival for advanced aged AML patients treated with azacitidine (AZA) or low dose cytosine arabinoside (LDCA) or venetoclax (Ven) with AZA combination.
Methods: Ninety-one patients were retrospectively analyzed.
Results: Forty-one patients treated with LDCA, 30 patients treated with AZA and 20 patients treated with AZA+Ven were included in the study. Patients who received these three treatments and who achieved response and did not receive any other treatment during the follow-up period were included in the study. Median age at diagnosis was 70. The percentage of patients who achieved neutrophil recovery after the first cycle was 27%, 73% and 50% of the patients treated with LDCA, AZA and AZA+Ven respectively. The rate of patients who achieved platelet recovery was 60%, 80%, 70% respectively. Erythrocyte transfusion independency was 54% for LDCA patients, 73% for AZA patients and 60% for combination therapy. Overall survival was longer in patients receiving AZA+Ven than other treatment groups while grade 3-4 infections were more common in the first cycle of the treatment.
Conclusion: According to our study, patients treated with AZA had better platelet and neutrophil recovery rates with also longer overall survival than patients treated with LDCA, but total overall survival was superior in AZA+Ven combination. Hypomethylating agents with venetoclax is a preferable treatment option in elderly AML patients.

Keywords : Acute myeloid leukemia, azacitidine, low dose cytosine arabinoside, venetoclax, elderly patients

Download Article


1. Shallis RM, Wang R, Davidoff A, Ma X, Zeidan AM.Epidemiology of acute myeloid leukemia: recent progress andenduring challenges. Blood Rev. 2019;36:70-87.
2. Swolin B, Rödjer S, Westin J. Therapy-related patterns of cytogeneticabnormalities in acute myeloid leukemia and myelodysplasticsyndrome post polycythemia vera: single center experience andreview of literature. Ann Hematol. 2008;87(6):467-474.
3. Surveillance, Epidemiology, and End Results (SEER) ProgramCancer Stat Facts: Leukemia-Acute Myeloid Leukemia (AML).Available at: https://seer.cancer.gov/statfacts/html/amyl.html
4. Döhner H, Estey E, Grimwade D, et al. Diagnosis andmanagement of AML in adults: 2017 ELN recommendationsfrom an international expert panel. Blood. 2017;129(4):424-447.
5. Oran B, Weisdorf DJ. Survival for older patients with acutemyeloid leukemia: a population-based study. Haematologica.2012;97(12):1916-1924.
6. Löwenberg B, Zittoun R, Kerkhofs H, et al. On the value ofintensive remission-induction chemotherapy in elderly patientsof 65+ years with acute myeloid leukemia: a randomized phase IIIstudy of the European Organization for Research and Treatmentof Cancer Leukemia Group. J Clin Oncol. 1989;7(9):1268-1274.
7. Tilly H, Castaigne S, Bordessoule D, et al. Low-dose cytarabineversus intensive chemotherapy in the treatment of acutenonlymphocytic leukemia in the elderly. J Clin Oncol. 1990;8(2):272-279.
8. Fenaux P, Mufti GJ, Hellström-Lindberg E, et al. Azacitidineprolongs overall survival compared with conventional careregimens in elderly patients with low bone marrow blast countacute myeloid leukemia. J Clin Oncol. 2010;28(4):562-569.
9. Dombret H, Seymour JF, Butrym A, et al. International phase3 study of azacitidine vs conventional care regimens in olderpatients with newly diagnosed AML with >30% blasts. Blood.2015;126(3):291-299.
10. DiNardo CD, Jonas BA, Pullarkat V, et al. Azacitidine andVenetoclax in previously untreated acute myeloid leukemia. NEngl J Med. 2020;383(7):617-629.
11. Guerra VA, DiNardo C, Konopleva M. Venetoclax-basedtherapies for acute myeloid leukemia. Best Pract Res ClinHaematol. 2019;32(2):145-153.
12. Döhner H, Wei AH, Appelbaum FR, et al. Diagnosis andmanagement of AML in adults: 2022 recommendations froman international expert panel on behalf of the ELN. Blood.2022;140(12):1345-1377.
13. Pollyea DA, Altman JK, Assi R, et al. Acute myeloid leukemia,version 3.2023, NCCN Clinical Practice Guidelines in Oncology.J Natl Compr Canc Netw. 2023;21(5):503-513.
14. Common Terminology Criteria for Adverse Events. Availablefrom: https://ctep.cancer.gov/protocoldevelopment/electronic_applications/docs/CTCAE_v5_Quick_Reference_8.5x11.pdf(Accessed on March 09, 2018).
15. García-Delgado R, de Miguel D, Bailén A, et al. Effectiveness andsafety of different azacitidine dosage regimens in patients withmyelodysplastic syndromes or acute myeloid leukemia. Leuk Res.2014;38(7):744-750.
16. Heiblig M, Elhamri M, Tigaud I, et al. Treatment with low-dosecytarabine in elderly patients (age 70 years or older) with acutemyeloid leukemia: a single institution experience. Mediterr JHematol Infect Dis. 2016;8(1):1-7.
17. Medeiros BC, Satram-Hoang S, Hurst D, Hoang KQ, Momin F,Reyes C. Big data analysis of treatment patterns and outcomesamong elderly acute myeloid leukemia patients in the UnitedStates. Ann Hematol. 2015;94(7):1127-1138.
18. Babakhanlou R, Ravandi-Kashani F. Non-intensive acute myeloidleukemia therapies for older patients. Expert Rev Hematol.2023;16(3):171-180.
19. Wei AH, Montesinos P, Ivanov V, et al. Venetoclax plus LDACfor newly diagnosed AML ineligible for intensive chemotherapy:a phase 3 randomized placebo-controlled trial. Blood. 2020;135(24):2137-2145.
20. Kenswil KJG, Pisterzi P, Feyen J, et al. Immune composition andits association with hematologic recovery after chemotherapeuticinjury in acute myeloid leukemia. Exp Hematol. 2022;105:32-38.
Article available in :
Volume 4, Issue 6, 2023
Page : 619-624
https://doi.org/10.47582/jompac.1365715
Article Information
Received : 25 Eyl 2023
Accepted : 17 Kas 2023
Published : 31 Ara 2023
Corresponding Author :

Ferda Can: Department of Hematology, Ankara Bilkent City Hospital, Ankara, Turkey

[email protected]
Citation : Can F, Yıkılmaz A, Gökçe D, et al. Comparison of low dose cytosine arabinoside, azacitidine and azacitidine venetoclax combination treatment as remission induction in elderly acute myeloid leukemia patients. J Med Palliat Care. 2023;4(6):619-624.

Read: 27
Cited: 0
Download : 76
_Footer