Analysis Of Non- Cytogenetic Prognostic Factors And Efficacy Of Induction Chemotherapy In Elderly Adults With Acute Myeloid Leukemia

Objective: To provide a clue for risk stratification and treatment strategies by analyzing the Non-cytogenetic prognostic factors and efficacy of Induction Chemotherapy in elderly adults with acute myeloid leukemia(AML).Method: The clinical data of 79 de novo AML patients aged 60 years old or more and treated in the He Ping Hospital affiliated Changzhi Medical Collage from January 2010 to October 2015 were collected and analyzed. The clinical data including sex, age, subtype, WBC counts, HGB, PLT counts, creatimine, lactate dehydrogenase(LDH), Eastern Cooperative Oncology Group(EOOG) scores, treatment, and remission of patients were investigated by univariate and multivariate analysis. The treatment strategies were talk about after the multivariate analysis.Results: The WBC counts, LDH, EOOG scores, achieved chemotherapy, and achieved remission were related to the survival of elderly adults with acute myeloid leukemia. Only the increased WBC counts, EOOG 3-4 and achieved non-remission(NR) were independent poor performance. For 53 elderly patients in induction chemotherapy, complete remission(CR) rate was 54.0%, early death rate was 5.7%, median overall survival(OS) was 11.8 months. For 26 elderly patients in palliative treatment, CR rate was 0%, early death rate was 23.1%, median OS was 1.4 months. The elderly patients in induction chemotherapy have a higher CR rate and longer median OS than in palliative treatment.There was no difference in early death between induction chemotherapy and palliative treatment. The elderly patients in induction chemotherapy received treatment of CAG, DA or micro-transplantation. For 27 elderly patients in CAG, CR rate was 48.1%, disease free survival rate at 6 months was 44.4%. For 18 elderly patients in DA, CR rate was 56.3%, disease free survival rate at 6 months was 43.8%. For 8 elderly patients in micro-transplantation, CR rate was 71.4%, disease free survival(DFS) rate at 6 months was 71.4%. The CR rate and DFS rate at 6 months in elderly patients of DA or micro-transplantation was higher than in CAG, but there were no significant differences between them. The median OS of patients in CAG, DA, micro-transplantation and palliative treatment was 11.7 months, 9.8 months, not reach, and 1.4 months. The patients in micro-transplantation have a longer median OS than in CAG, DA or palliative treatment. Although there was no difference between patients in CAG and DA, they have a longer median OS than palliative treatment. The median OS of elderly patients with ECOG 0~2 in CAG, DA, and palliative treatment was 15.8 months, 24.4 months and 1.5 months. Though there was no difference between the patients in CAG and DA, they have longer survival than palliative treatment. The median OS of patients with ECOG 3~4 in CAG, DA, and palliative treatment was 7.2 months, 3.1 months and 1.1 months. The median OS of patients in CAG was longer than in DA and palliative treatment, and the patients in DA did not have a longer survival than in palliative treatment.Conclusion: The Non-cytogenetic prognostic factors, such as increased WBC counts, EOOG 3-4 and achieved non-remission, were independent poor performance. The treatment strategies of elderly adults with acute myeloid leukemia may different among different patients and the elderly adults with AML should be treated individually. Micro-transplantation may improve the survival of elderly adults with acute myeloid leukemia.