Table 1.

Weighted Scores of Comorbidities as Summarized by the HCT-CI

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Ringdén O, Labopin M, Ehninger G, et al. Reduced intensity conditioning compared with myeloablative conditioning using unrelated donor transplants in patients with acute myeloid leukemia. J Clin Oncol 2009;27:4570–4577.
Appelbaum FR, Gundacker H, Head DR, et al. Age and acute myeloid leukemia. Blood 2006;107:3481–3485.
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Buchner T, Berdel WE, Schoch C, et al. Therapeutic outcome in prognostic subgroups of de-novo acute myeloid leukemia (AML) and the role of the age factor: a study in 1834 patients of 16 to 84 years [abstract]. J Clin Oncol 2005;23(Suppl 1):Abstract 6552.
Delaunay J, Vey N, Leblanc T, et al. Prognosis of inv(16)/t(16;16) acute myeloid leukemia (AML): a survey of 110 cases from the French AML Intergroup (Review). Blood 2003;102:462–469.
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Wheatley K, Brookes CL, Howman AJ, et al. Prognostic factor analysis of the survival of elderly patients with AML in the MRC AML11 and LRF AML14 trials. Br J Haematol 2009;145:598–605.
Lowenberg B, Ossenkoppele GJ, van Putten W, et al. High-dose daunorubicin in older patients with acute myeloid leukemia. N Engl J Med 2009;361:1235–1248.
Buchner T, Berdel WE, Haferlach C, et al. Age-related risk profile and chemotherapy dose response in acute myeloid leukemia: a study by the German Acute Myeloid Cooperative Group. J Clin Oncol 2009;27:61–69.
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Pigneux A, Harousseau JL, Witz F, et al. Addition of lomustine to idarubicin and cytarabine improves the outcome of elderly patients with de novo acute myeloid leukemia: a report from the GOELAMS. J Clin Oncol 2010;28:3028–3034.
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Author(s)

Boglarka Gyurkocza, MD

Clinical Research Division, Fred Hutchinson Cancer Research Center, University of Washington School of Medicine, Seattle, Washington

Disclosures

Disclosure: Boglarka Gyurkocza, MD, has disclosed no relevant financial relationships.

Frederick R. Appelbaum, MD

Clinical Research Division, Fred Hutchinson Cancer Research Center, University of Washington School of Medicine, Seattle, Washington

Disclosures

Disclosure: Frederick R. Appelbaum, MD, has disclosed no relevant financial relationships.

Editor(s)

Kerrin M. Green, MA

Assistant Managing Editor, Journal of the National Comprehensive Cancer Network

Disclosures

Disclosure: Kerrin M. Green, MA, has disclosed no relevant financial relationships.

CME Author(s)

Charles P. Vega, MD

Associate Professor; Residency Director, Department of Family Medicine, University of California, Irvine

Disclosures

Disclosure: Charles P. Vega, MD, has disclosed no relevant financial relationships.

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Nafeez Zawahir, MD

CME Clinical Director, Medscape, LLC

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Disclosure: Nafeez Zawahir, MD, has disclosed no relevant financial relationships.

Sarah Fleischman

CME Program Manager, Medscape, LLC

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Disclosure: Sarah Fleischman has disclosed no relevant financial relationships.

CME

Identifying Older Patients With Acute Myeloid Leukemia Who May Be Candidates for Reduced-Intensity Hematopoietic Cell Transplantation

Authors: Boglarka Gyurkocza, MD; Frederick R. Appelbaum, MD
CME Released: 3/7/2011
THIS ACTIVITY HAS EXPIRED FOR CREDIT
Valid for credit through: 3/7/2012, 11:59 PM EST

Start Activity

Target Audience and Goal Statement

This activity is intended for oncologists and other physicians who care for patients with AML.

The goal of this activity is to evaluate the efficacy and safety of reduced-intensity HCT among older adults.

Upon completion of this activity, participants will be able to:

Describe the diagnosis of AML among older adults
Evaluate the efficacy of reduced-intensity HCT among older adults with AML
Analyze variables associated with worse prognosis of reduced-intensity HCT among older adults with AML
Distinguish advantages of reduced-intensity HCT among older adults with AML

Disclosures

Author(s)

Boglarka Gyurkocza, MD

Clinical Research Division, Fred Hutchinson Cancer Research Center, University of Washington School of Medicine, Seattle, Washington

Disclosures

Disclosure: Boglarka Gyurkocza, MD, has disclosed no relevant financial relationships.

Frederick R. Appelbaum, MD

Clinical Research Division, Fred Hutchinson Cancer Research Center, University of Washington School of Medicine, Seattle, Washington

Disclosures

Disclosure: Frederick R. Appelbaum, MD, has disclosed no relevant financial relationships.

Editor(s)

Kerrin M. Green, MA

Assistant Managing Editor, Journal of the National Comprehensive Cancer Network

Disclosures

Disclosure: Kerrin M. Green, MA, has disclosed no relevant financial relationships.

CME Author(s)

Charles P. Vega, MD

Associate Professor; Residency Director, Department of Family Medicine, University of California, Irvine

Disclosures

Disclosure: Charles P. Vega, MD, has disclosed no relevant financial relationships.

CME Reviewer(s)

Nafeez Zawahir, MD

CME Clinical Director, Medscape, LLC

Disclosures

Disclosure: Nafeez Zawahir, MD, has disclosed no relevant financial relationships.

Sarah Fleischman

CME Program Manager, Medscape, LLC

Disclosures

Disclosure: Sarah Fleischman has disclosed no relevant financial relationships.

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From JNCCN - Journal of the National Comprehensive Cancer Network

CME

Identifying Older Patients With Acute Myeloid Leukemia Who May Be Candidates for Reduced-Intensity Hematopoietic Cell Transplantation

Authors: Boglarka Gyurkocza, MD; Frederick R. Appelbaum, MDFaculty and Disclosures

THIS ACTIVITY HAS EXPIRED FOR CREDIT

CME Released: 3/7/2011

Valid for credit through: 3/7/2012, 11:59 PM EST

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Abstract and Introduction

Abstract

Recent studies show that with reduced-intensity and nonmyeloablative conditioning regimens, allogeneic hematopoietic cell transplantation can now be performed with relative safety in patients with acute myeloid leukemia up to 75 years of age, and therefore chronologic age itself should no longer be considered a contraindication for this procedure. Best results are generally seen in patients undergoing transplant during first remission. Results appear superior to what might be expected with conventional chemotherapy but prospective randomized trials have not been completed. If a decision is made to delay transplant until first relapse, a careful monitoring plan should be established. (JNCCN 2011;9:319–330)

Introduction

The prevalence of acute myeloid leukemia (AML) increases with age, with a median patient age of 67 years at diagnosis, according to SEER statistics (www.seer.cancer.gov). The biology of AML differs between older and younger patients, with an increased incidence of antecedent myelodysplasia, a greater proportion of poor-prognosis cytogenetics, and higher expression of multidrug-resistant glycoprotein MDR1.^[1–4] Patients older than 60 years and those with comorbid conditions are usually treated with less-intense regimens because of their presumed inability to tolerate multiple cycles of high-dose chemotherapy. The combination of less-intensive therapy and inherently more resistant disease results in a very poor prognosis.^[5,6]

A recent retrospective analysis including 2444 patients with AML, aged 60 years or older, treated on several SWOG, ECOG, and MD Anderson Cancer Center protocols between 1976 and 2004, reported a 5-year overall survival rate of 7%.^[7] The application of allogeneic hematopoietic cell transplantation (HCT) to patients with AML in this age group had previously been limited by high rates of transplant-related mortality (TRM) caused by toxicities from high-dose conditioning regimens.^[8,9] The development of reduced-intensity and nonmyeloablative conditioning regimens now allows for the study of allogeneic HCT in older and medically less-fit patients.^[10–22] These approaches rely on graft-versus- leukemia (GVL) effects for leukemia eradication. Preliminary studies have yielded encouraging results, but inherent selection bias and the lack of prospective randomized trials have caused the true impact of allogeneic HCT for this patient population to be uncertain. This article provides an overview of reduced-intensity and nonmyeloablative conditioning allogeneic HCT in older patients with AML, with particular emphasis on disease- and patient-related factors influencing outcomes.

Page 1 of 6

Biology of AML in Older Adults

CME Information

References

References

Disclaimer

The material presented here does not necessarily reflect the views of Medscape, LLC, or companies that support educational programming on www.medscape.org. These materials may discuss therapeutic products that have not been approved by the US Food and Drug Administration and off-label uses of approved products. A qualified healthcare professional should be consulted before using any therapeutic product discussed. Readers should verify all information and data before treating patients or employing any therapies described in this educational activity.

Table 1.

References

Faculty and Disclosures

Author(s)

Boglarka Gyurkocza, MD

Frederick R. Appelbaum, MD

Editor(s)

Kerrin M. Green, MA

CME Author(s)

Charles P. Vega, MD

CME Reviewer(s)

Nafeez Zawahir, MD

Sarah Fleischman

CME

Identifying Older Patients With Acute Myeloid Leukemia Who May Be Candidates for Reduced-Intensity Hematopoietic Cell Transplantation

Target Audience and Goal Statement

Disclosures

Author(s)

Boglarka Gyurkocza, MD

Frederick R. Appelbaum, MD

Editor(s)

Kerrin M. Green, MA

CME Author(s)

Charles P. Vega, MD

CME Reviewer(s)

Nafeez Zawahir, MD

Sarah Fleischman

Accreditation Statements

For Physicians

Instructions for Participation and Credit

Identifying Older Patients With Acute Myeloid Leukemia Who May Be Candidates for Reduced-Intensity Hematopoietic Cell Transplantation

Abstract and Introduction

Abstract

Introduction

Table of Contents