57 / 154
A B S T R A C T S
S27
O07
WHAT EVIDENCE DO WE HAVE FOR TREATING RELAPSED/
REFRACTORY AML IN PATIENTS 70 AND OLDER? A
SYSTEMATIC REVIEW OF THE LITERATURE
M. Extermann
1,2,
*, M. Sehovic
1
, T. Rejlic
2
, J. Kim
3
, J. Lancet
2,4
,
B. Djulbegovic
2,4
1
Senior Adult Oncology Program, Moffitt Cancer Center,
2
University
of South Florida,
3
Biostatistics Core,
4
Hematology Program, Moffitt
Cancer Center, Tampa, USA
Introduction:
The prognosis of acute myeloid leukemia
(AML) worsens with age, and older patients treated with
intensive regimens often relapse. Prognosis is particularly poor
in patients over the age of 70 (70+). However, no systematic
review of the evidence is available for 2nd line treatment in
this age group.
Objectives:
Analyze the published evidence on treating
relapsed AML in patients 70+.
Methods:
We conducted a systematic review of the
literature on treatment of older AML patients in 1st relapse
(keywords: acute myeloid leukemia, elderly, relapse, post
remission, post induction), published through June 2015,
including articles reporting combined data on relapsed/
refractory AML patients. We found 631 articles, of which 64
included at least 20 patients and at least 1 patient aged 70+.
Studies that involved the pediatric population(49), did not
include patients 70+(56), were not AML studies(81), were not
relapse/refractory studies(184), had no reported outcomes of
interest(161), and phase I studies(36), were excluded. Data
were extracted, grouped, and summarized, using descriptive
statistics where appropriate.
Results:
Sixty-four articles were reviewed: 8 Phase II
single-agent studies, 27 prospective and 15 retrospective
cohort studies, and 14 randomized clinical trials (RCTs). Only
3 studies reported data on the 70+ population. Most of these
studies used various intensive regimens. Several studies
used low dose chemotherapies, targeted therapies, and
hypomethylating agents.
Phase II studies reported on a population with median age
ranging from 51 to 69. Rates of 2nd complete remission (CR2)
were reported in 7 studies and ranged from 8 to 56%. Data on
early death rates (30-day mortality) were available in 4 articles
and ranged from 11 to 20%. Median overall survival (OS) was
reported in 5 studies ranging from 3.2 to 12 months.
Median age in 27 prospective cohort studies ranged from 42
to 73. CR2 rates were reported in 25 studies ranging from 16 to
83%. Early death rates were available in 9 studies ranging from
1 to 21%. Median OS in 15 studies ranged from 2.5 to 14 months.
Median age in 15 retrospective studies ranged from 43 to
70. CR2 rates were available in 13 studies ranging from 10 to
88%. Early death rates were reported in 8 studies and ranged
from 3.4 to 22%. Data on median OS were available in 13
studies ranging from 2 to 10.6 months.
Median age in 14 RCTs was from 46 to 73. CR2 rates ranged
from 0 to 53%. Early death rates, reported in 8 studies, ranged
from 5 to 25%. Median OS data were available in 10 studies
and ranged from 2.4 to 11 months.
Only 3 studies reported specific data on the 70+ population.
One study using novel agents (clofarabine and temsirolimus)
reported data on 21 patients 70 and older, with CR2 rates of
8%. The 2nd study using intensive chemotherapy (high dose
cytarabine, mitoxantrone, and L-asparaginase) reported data
on 26 patients with CR2 rates of 31% and early death rates
of 23%. The 3rd study using low dose chemotherapy (low
dose cytarabine, aclarubicin, and G-CSF) reported data on 8
patients with CR2 rates of 50% and median OS of 10 months.
Conclusion:
In the current literature, no study included only
AML patients 70+ in first relapse. Very few studies reported
subgroup data, and their results widely varied. Future studies
should address that unmet evidence need by including more
AML patients 70+ treated with 2nd line regimens and report
specific subgroup results for this population.
Disclosure of interest:
M. Extermann Grant/Research
Support from: GTx, M. Sehovic: None declared, T. Rejlic: None
declared, J. Kim: None declared, J. Lancet Grant/Research
Support from: Celgene, Pfizer, Consultant for: AMGEN,
Asterias Biotherapeutics, Baxalta, Boehringer Ingelheim,
Celgene, Karyopharm Therapeutics, Novartis, B. Djulbegovic:
None declared
Keywords:
AML, relapsed AML, systematic review
O08
EARLY CASE MANAGEMENT IN THE OLDER FRENCH
HEMATOLOGICAL MALIGNANCIES PATIENT RECEIVING
CHEMOTHERAPY, PRELEMINARY RESULTS
J. B. Fargeas
1,
*, Nicolas Signol, Marie-Agnès Picat,
Diane Tilmant-Tatischeff, Julie Abraham, Marie-Pierre Gourin,
Arnaud Jaccard, Dominique Bordessoule
1
CHU, Limoges, France
Introduction:
As haematological malignancies (HM)
occurred mainly in elderly patients (PTS), geriatrics screening
tool followed if necessary by a comprehensive geriatric
assessment (CGA) are used in routine. If this early assessment
leads to identify and manage frailty, or disabilities, it is known
that case management (CM) in frailty patients could promote
continuity of care, decrease hospitalization rates and preserve
quality of life in other pathologies. The aim of this work is
to study the benefit of a personalized follow-up managed
with early CM by a geriatric team for selected high risk PTS
with HM treated by chemotherapy, through clinical visits and
nurse phone calls.
Objectives:
to assess the effectiveness of an early CM in
the follow up of selected frail patients with HM receiving
chemotherapy on care organization. Minor objective :1) to
describe the nature of team intervention, 2) to observe the
ratio of non-planned hospitalisation and severe adverse
event occurrence, 3) to report adherence to chemotherapy, 4)
to assess patient satisfaction.
Methods:
Prospective study on all consecutive PTS, treated
by chemotherapy from February to March 2016. Criteria: 1)
70 years and older 2) proved diagnosis of HM 3) first line and
relapse sequential intravenous chemotherapy 4) Frail PTS
selected by a) nurse geriatric screening with GERH-7 tool b)
medical comprehensive geriatric assessment according to the