Cancers (Aug 2021)
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)
- 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
Affiliations
- Bożena Katarzyna Budziszewska
- Department of Hematology, Institute of Hematology and Transfusion Medicine, 02-776 Warsaw, Poland
- Aleksander Salomon-Perzyński
- Department of Hematology, Institute of Hematology and Transfusion Medicine, 02-776 Warsaw, Poland
- Katarzyna Pruszczyk
- Department of Hematology, Institute of Hematology and Transfusion Medicine, 02-776 Warsaw, Poland
- Joanna Barankiewicz
- Department of Hematology, Institute of Hematology and Transfusion Medicine, 02-776 Warsaw, Poland
- Agnieszka Pluta
- Department of Hematology, Medical University of Lodz, 93-513 Lodz, Poland
- Grzegorz Helbig
- Department of Hematology and Bone Marrow Transplantation, School of Medicine in Katowice, Medical University of Silesia, 40-032 Katowice, Poland
- Anna Janowska
- Department of Hematology, Medical University of Lodz, 93-513 Lodz, Poland
- Marta Kuydowicz
- Department of Hematology, Medical University of Lodz, 93-513 Lodz, Poland
- Łukasz Bołkun
- Department of Hematology, Medical University of Bialystok, 15-276 Bialystok, Poland
- Jarosław Piszcz
- Department of Hematology, Medical University of Bialystok, 15-276 Bialystok, Poland
- Elżbieta Patkowska
- Department of Hematology, Institute of Hematology and Transfusion Medicine, 02-776 Warsaw, Poland
- Marzena Wątek
- Department of Hematology, Institute of Hematology and Transfusion Medicine, 02-776 Warsaw, Poland
- Piotr Małecki
- Department of Hematology and Cancer Prevention, Faculty of Health Sciences, Medical University of Silesia, 40-055 Katowice, Poland
- Sylwia Kościołek-Zgódka
- Center of Oncology, Hematology Department, 25-734 Kielce, Poland
- Edyta Cichocka
- Hematology Department, Nicolaus Copernicus Hospital, 87-100 Torun, Poland
- Grzegorz Charliński
- Warmian-Masurian Cancer Center of The Ministry of The Interior and Administration’s Hospital, Department of Hematology, 10-228 Olsztyn, Poland
- Anna Irga-Staniukiewicz
- Department of Hematology and Transplantology, Medical University of Gdansk, 80-952 Gdansk, Poland
- Jan Maciej Zaucha
- Department of Hematology and Transplantology, Medical University of Gdansk, 80-952 Gdansk, Poland
- Agnieszka Piekarska
- Department of Hematology and Transplantology, Medical University of Gdansk, 80-952 Gdansk, Poland
- Tomasz Gromek
- Department of Hematooncology and Bone Marrow Transplantation, Medical University of Lublin, 20-081 Lublin, Poland
- Marek Hus
- Department of Hematooncology and Bone Marrow Transplantation, Medical University of Lublin, 20-081 Lublin, Poland
- Karol Wójcik
- Hematology Department, Rydygier Memorial Hospital, 31-826 Krakow, Poland
- Małgorzata Raźny
- Hematology Department, Rydygier Memorial Hospital, 31-826 Krakow, Poland
- Mariola Sędzimirska
- Lower Silesian Centrum for Cellular Transplantation, 53-439 Wroclaw, Poland
- Bartosz Puła
- Department of Hematology, Institute of Hematology and Transfusion Medicine, 02-776 Warsaw, Poland
- Sebastian Giebel
- Department of Bone Marrow Transplantation and Onco-Hematology, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, 44-102 Gliwice, Poland
- Sebastian Grosicki
- Department of Hematology and Cancer Prevention, Faculty of Health Sciences, Medical University of Silesia, 40-055 Katowice, Poland
- Agnieszka Wierzbowska
- Department of Hematology, Medical University of Lodz, 93-513 Lodz, Poland
- Ewa Lech-Marańda
- Department of Hematology, Institute of Hematology and Transfusion Medicine, 02-776 Warsaw, Poland
- DOI
- https://doi.org/10.3390/cancers13164189
- Journal volume & issue
-
Vol. 13,
no. 16
p. 4189
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.
Keywords