Efficacy Of Chemotherapy And Prognostic Analysis In Elderly Patients With Acute Myeloid Leukemia

Objective: To explore the outcome of chemotherapy and non-cytogeneticprognostic analysis in elderly patients with acute myeloid leukemia(AML).Methods: The clinical data of131AML patients over the60years old inthe second hospital affliate to the Hebei Medical University from May2005toOctober2012were analyzed retrospectively.46patients received supportivecare, including using of antibiotics, transfusion of blood products.42patientsreceived standard chemotherapy including regimen DA and IA.32patientsreceived low-dose chemotherapy which is standard dose of30%to60%.11patients received regimen CAG. The outcome of strategy was comparedbetween supportive care group and chemotherapy group. The effect ofcomparing the three chemotherapy group. Comparison of three differentchemotherapy regimens by70years old respectively. The outcome ofchemotherapy was compared between regimen IA and DA. Univatiate andmultivariate analysis of prognostic factors were preformed using a Coxregression model and log-rank test, including gender, age, etiology, CCI scores,numeration of leukocyte, erythrocyte count and thrombocyte count, lacticdehydrogenase, proportion of bone marrow primitive cell, CD34level andtreatment strategy.Results: The complete remission rate was40%in85patients withchemotherapy compare with none of the46patients with supportive care. Themedian overall survival time was129days in85patients with chemotherapycompare with35days in46patients with supportive care (P＜0.05). Thecomplete remission rate was57.1%in42patients with standard chemotherapycompare with25%in32patients with low-dose chemotherapy（X~2=9.280,P＜0.05). The overall response rate was61.9%in42patients with standardchemotherapy compare with31.3%in32patients with low-dose chemotherapy（X~2=6.832,P＜0.05). The overall response rate was61.9%in42patients with standard chemotherapy compare with27.3%in11patients withregimen CAG（X~2=4.220,P＜0.05). The median overall survival time was210days,109days and53days respectively among the three chemotherapygroups (P＜0.05). In the standard chemotherapy group, the completeremission rate was12.5%in8patients over70years old compare with67.6%in34patients with60to70years old (P＜0.05). The overall responseremission rate was12.5%in8patients over70years old compare with73.5%in34patients with60to70years old (P＜0.05). The mortality rate was25%in8patients over70years old compare with2.9%in34patients with60to70years old (P＜0.05). The median overall survival time was124days in8patients over70years patients compare with720days in34patients with60to70years old (P＜0.05). In the standard chemotherapy group,The completeremission rate was55.2%with IA regimen compare with61.5%with DAregimen (P=0.700). The overall response rate was58.6%with IA regimencompare with69.2%with DA regimen (P=0.513). The mortality rate was6.9%with IA regimen compare with7.7%with DA regimen (P=0.926).Themedian overall survival time was720days with IA regimen compare with605days with DA regimen (P=0.643). The median relapse-free survival was262days with IA regimen compare with210days with DA regimen (P=0.051).Age, etiology, numeration of leukocyte, and thrombocyte count, receivingchemotherapy or not were adverse prognostic factors of the survival time withunivariate analysis. Secondary leukemia, hyperleukocytosis (WBC≥100×109/L)and not receiving chemotherapy were independent poor factors affecting thesurvival time with multivariate analysis.Conclusions: Receiving chemotherapy is significant to the elderlypatients. The elderly patients should be evaluated before the individualizedchemotherapy. So, they can gain higher CR rate, prolong the survival time.The patients with60to70years old and received standard chemotherapy cangain higher CR rate, prolong the survival time. The patients with secondaryleukemia, hyperleukocytosis (WBC≥100×109/L) and without receiving chemotherapy have poor prognosis.