Age affects survival significantly in AML patients. Elderly AML patients are generally offered palliative treatment instead of induction chemotherapy. However, studies by Pigneus and other research groups suggest that elderly patients with AML should not be excluded systematically from intensive chemotherapy protocols. They found that elderly patients who received chemotherapy achieved longer survival times than those who refused treatment or received supportive treatment alone. Unfortunately, many of these patients suffer serious or fatal complications during treatment [
13‐
20]. For example, Alymara et al. reported a study in which 23.7% of the 38 patients older than 60 years of age who received chemotherapy using idarubicin (8 mg/m
2 for 3 days), Ara-c (100 mg/m
2 for 5 days), and etoposide (75 mg/m
2 for 5 days) achieved CR, while 34.2% patients achieved PR. However, during the treatment, 42.1% of their patients died of infection, cerebrovascular or gastrointestinal hemorrhage, or acute myocardial infarction [
15].
An Eastern Collaborative Oncology Group study randomized elderly AML patients to remission induction therapy with either daunorubicin, idarubicin, or mitoxantrone along with a standard dose of Ara-C and priming with GM-CSF. The outcomes were not significantly different in the three arms, with CR rates ranging from 40% to 46%, median survival 8 months, and a 15% treatment related death [
21].
In the present retrospective study, we have studied the outcomes in elderly patients who were treated with induction chemotherapy of HA protocol in this hospital. In the previous study of Jin et al [
7], a homoharritonine-based regimen (HAA: homoharritonine 4 mg/m
2/day, days 1–3; cytarabine 150 mg/m
2/day, days 1–7; aclarubicin 12 mg/m
2/day, days 1–7) was shown to be a well-tolerated, effective induction regimen in young adult patients with de novo AML. Eighty-three percent of patients achieved CR, the estimated 3 years OS rate was 53%, whereas for patients with M5, the estimated OS rate at 3 years was 75%. In our study, the response results of HA are comparable with these and other reported results in elderly patients with AML [
15‐
21]. The response rates of HA are also comparable with the data of elderly patients treated with DA (daunorubicin 40 mg/m
2/d for 3 days; Ara-c, 100 mg/m
2/day for 7 days) or IDA (idarubicin 6 mg/m
2/d for 3 days; Ara-c, 100 mg/m
2/day for 7 days) protocols in our center during the same period. The differences in CR, OR rates and estimated median OS times between HA, DA, IDA groups were not statistically significant (Table
2). The results suggest that HA is also an effective induction regimen with less toxicity in elderly patients with AML. Furthermore, 3 of the 7 patients with AML secondary to MDS achieved CR, suggesting HA regimen is also effective in elderly patients with AML secondary to MDS. The toxicity of HA regimen protocol was relatively low. There was no early death in these patients treated with HA regimen and no severe cardiotoxicity was shown, while the ED rate within the first month of induction therapy in patients treated with DA and IDA from this same hospital was high (19.5% and 23.8%, respectively, Table
2), suggesting that HA regimen may be better tolerated in elderly patients with AML. A prospective study on this regimen for elderly AML patients is warranted.
Table 2
Response results of HA, DA and IDA regimens as induction chemotherapy in the treatment of elderly AML patients.
CR (%) | 39.1 | 38.1 | 57.1 |
OR (%) | 56.5 | 47.6 | 61,9 |
ED (%) | 0 | 19.5 | 23.8 |
OS time (m) | 12.0 ± 3.0 | 14.0 ± 4.7 | 8.0 ± 1.3 |