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Adding lomustine to induction therapy improved outcomes in elderly patients with AML
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Lomustine added to standard induction therapy improved complete remission and survival in patients aged older than 60 years with de novo acute myeloid leukemia.
Researchers retrospectively analyzed data from three studies with 339 patients assigned idarubicin and cytarabine and 508 patients assigned idarubicin, cytarabine and lomustine (Ceenu, Bristol-Myers Squibb).
The complete remission rate was 68% in the treatment group assigned therapy with lomustine vs. 58% in the group without lomustine. Median OS was also higher in the lomustine treatment group (12.7 months) compared with the group without lomustine (8.7 months; P=.004).
In multivariate analysis, the addition of lomustine (RR=1.2; 95% CI, 1.1-1.3) and nonadverse cytogenic profile (RR=1.2; 95% CI, 1.1-1.3) were associated with achievement of complete remission.
Nonadverse cytogenic profile (RR=1.4; 95% CI, 1.2-1.6), ECOG performance status (RR=1.4; 95% CI, 1.1-1.6), age 69 years or younger (RR=1.4; 95% CI, 1.2-1.6), addition of lomustine to induction chemotherapy (RR=1.3; 95% CI, 1.1-1.5) and French-American-British subtype 1/2 (RR=1.2; 95% CI, 1-1.4) were associated with OS.
There were significant differences between treatment groups for incidence of grade-3 and grade-4 toxicities, including hematologic toxicity, median days in hospital, nausea and mucositis. Rate of toxic death, however, was similar between the groups.
For more information:
- Pigneux A.J Clin Oncol. 2010;doi:10.1200/JCO.2009.26.4648.