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Leukemia & Lymphoma Volume 59, 2018 - Issue 5
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Original Articles: Clinical

Real life experience with frontline azacitidine in a large series of older adults with acute myeloid leukemia stratified by MRC/LRF score: results from the expanded international E-ALMA series (E-ALMA+)

José FalantesDepartment of Hematology, University Hospital Virgen del Rocío, Seville, Spain;
,
Lisa Pleyer3rd Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Laboratory for Immunological and Molecular Cancer Research, Oncologic Center, Paracelsus Medical University Hospital Salzburg, Salzburg, Austria; ;Salzburg Cancer Research Institute – Center for Clinical Cancer and Immunology Trials, Salzburg, Austria; ;Cancer Cluster Salzburg, Salzburg, Austria;
,
Sylvain ThépotDepartment of Blood Diseases/Hematology, CHU Angers, Angers, France;
,
António M. AlmeidaDepartment of Hematology, Instituto Português de Oncologia Francisco Gentil, Lisbon, Portugal;
,
Luca MaurilloDepartment of Hematology, Tor Vergata Foundation Polyclinic, University of Rome, Rome, Italy;
,
Violeta Martínez-RoblesDepartment of Hematology, University Hospital, León, Spain;
,
Reinhard StauderDepartment of Internal Medicine V (Hematology and Oncology), Innsbruck Medical University, Innsbruck, Austria;
,
Raphael ItzyksonDepartment of Hematology, Saint Louis Hospital, Paris VII University (APHP), Paris, France;
,
Ricardo PintoDepartment of Hematology, Hospital São João, Porto, Portugal;
,
Adriano VendittiDepartment of Hematology, Tor Vergata Foundation Polyclinic, University of Rome, Rome, Italy;
,
Joan BargayDepartment of Hematology, Son Llatzer Hospital, Palma de Mallorca, Spain;
,
Sonja BurgstallerDepartment of Internal Medicine IV, Wels-Grieskirchen Hospital, Wels, Austria;
,
María Pilar MartínezDepartment of Hematology, Doce de Octubre University Hospital, Madrid, Spain;
,
Valerie SeegersDepartment of Hematology, Avicenne Hospital, Paris XIII University (APHP), Bobigny, France;
,
Emilia CortesãoDepartment of Hematology, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal;
,
María Ángeles FoncillasDepartment of Hematology, Infanta Leonor University Hospital, Madrid, Spain;
,
Claude GardinDepartment of Hematology, Avicenne Hospital, Paris XIII University (APHP), Bobigny, France;
,
Pau MontesinosDepartment of Hematology, La Fe University Hospital, Valencia, Spain;
,
Pellegrino MustoScientific Direction, IRCCS-CROB Referral Cancer Center of Basilicata, Rionero in Vulture, Italy;
,
Pierre FenauxDepartment of Hematology, Saint Louis Hospital, Paris VII University (APHP), Paris, France;
,
Richard Greil3rd Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Laboratory for Immunological and Molecular Cancer Research, Oncologic Center, Paracelsus Medical University Hospital Salzburg, Salzburg, Austria; ;Salzburg Cancer Research Institute – Center for Clinical Cancer and Immunology Trials, Salzburg, Austria; ;Cancer Cluster Salzburg, Salzburg, Austria;
,
Miguel Angel SanzDepartment of Hematology, La Fe University Hospital, Valencia, Spain;
,
Fernando RamosDepartment of Hematology, University Hospital, León, Spain; ;Institute of Biomedicine, University of León, León, SpainCorrespondence[email protected]
& for the European ALMA + Investigators show all
Pages 1113-1120 | Received 13 Mar 2017, Accepted 31 Jul 2017, Published online: 24 Aug 2017
 
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Abstract

Azacitidine (AZA) prolonged overall survival (OS) in the AZA-AML-001 trial. However, few subjects were randomized to AZA or intensive chemotherapy (IC). The Medical Research Council (MRC) and the Leukemia Research Foundation (LRF) developed a score for older AML patients receiving IC or non-intensive regimens, whereas the E-ALMA study validated a score for survival and response in elderly patients receiving AZA in daily practice. Both identified three groups with different risk estimates. This analysis evaluates the efficacy of frontline AZA in older AML patients (N = 710) unfit for IC from different national registries (E-ALMA + series) stratified by the MRC/LRF risk score. Median OS of patients categorized as good, standard and poor-risk groups by the MRC/LRF score was 13.4 (95% CI, 10.8–16), 12.4 (95% CI, 9.9–14.8), and 8.1 months (95% CI, 7–9.1), respectively (p = .0001). In conclusion, this is the largest retrospective cohort of older AML patients treated with AZA.

Acknowledgments

This work was presented in part in abstract form at the 57th annual meeting of the American Society of Hematology, Orlando, FL. December 5–8, 2015.

Potential conflict of interest

Disclosure forms provided by the authors are available with the full text of this article online at http://dx.doi.org/10.1080/10428194.2017.1365854.

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