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Medicina & Laboratorio

2023, Number 4

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Medicina & Laboratorio 2023; 27 (4)

Treatment patterns and clinical outcomes in acute myeloid leukemia patients who are not eligible for intensive induction chemotherapy: A real-world study from Latin-America

Gálvez-Cárdenas KM, Enciso-Olivera LJ, Samanez-Figari CA, Quintana-Truyenque S, Castillo-Ríos BA, Quintero-Vega GE, Arrieta-López E, Pinto-Gómez AJ, Aruachan-Vesga S, Durán-Sánchez MI, Espino-Lopéz G

Language: English
References: 39
Page: 315-332
PDF size: 146.04 Kb.


ABSTRACT

Introduction. There is a knowledge gap concerning patients with acute myeloid leukemia (AML) who are not eligible for intensive induction chemotherapy; this, together with a recent increase in the incidence in Latin America, encloses a need. Through real-world evidence, we describe and compare the results of the different treatment strategies within this context. Methodology. This is a longitudinal, descriptive, retrospective study of a cohort of Latin American patients with AML not eligible for intensive induction chemotherapy, treated with low-intensity chemotherapy or with the best supportive care alone between January 1, 2015, to December 31, 2018. Results. Of a total of 125 patients (median age 74.8 years), the majority received low-intensity chemotherapy (78.4%). The median time in months of overall survival, progression-free survival, and time to treatment failure were longer in patients receiving hypomethylating agents. Additionally, better results were observed with low-intensity chemotherapy (complete response 11.2% and stable disease 17.3%) compared to the best supportive care alone. Conclusion. We deliver a real-world standpoint of Latin American patients with AML who are not eligible for intensive induction chemotherapy. Our findings pave the first steps of the way to describe, understand, and support informed decision-making processes in our region.


REFERENCES

  1. Döhner H, Weisdorf DJ, Bloomfield CD.Acute myeloid leukemia. N Engl J Med 2015;373:1136-1152. https://doi.org/10.1056/NEJMra1406184.

  2. American Cancer Society. Key statistics foracute myeloid leukemia (AML). Georgia, EstadosUnidos: American Cancer Society; 2021.Available from https://www.cancer.org/cancer/acute-myeloid-leukemia/about/key-statistics.html.

  3. Dong Y, Shi O, Zeng Q, Lu X, Wang W, Li Y,et al. Leukemia incidence trends at the global,regional, and national level between 1990 and2017. Exp Hematol Oncol 2020;9:14. https://doi.org/10.1186/s40164-020-00170-6.

  4. Yi M, Li A, Zhou L, Chu Q, Song Y, Wu K. Theglobal burden and attributable risk factor analysisof acute myeloid leukemia in 195 countriesand territories from 1990 to 2017: estimatesbased on the global burden of disease study2017. J Hematol Oncol 2020;13:72. https://doi.org/10.1186/s13045-020-00908-z.

  5. United Nations (UN). World population ageing.New York, USA: United Nations, Departmentof Economic and Social Affairs; 2019.Available from https://www.un.org/en/development/desa/population/publications/pdf/ageing/WorldPopulationAgeing2019-Report.pdf.

  6. Ou Z, Yu D, Liang Y, He W, Li Y, Zhang M, et al.Analysis of the Global Burden of Disease studyhighlights the trends in death and disability-adjustedlife years of leukemia from 1990 to 2017.Cancer Commun (Lond) 2020;40:598-610.https://doi.org/10.1002/cac2.12094.

  7. Bewersdorf JP, Shallis RM, Wang R, HuntingtonSF, Perreault S, Ma X, et al. Healthcareexpenses for treatment of acute myeloid leukemia.Expert Rev Hematol 2019;12:641-650.https://doi.org/10.1080/17474086.2019.1627 869.

  8. Gao L, Nguyen D, Lee P. A systematic review ofeconomic evaluations for the pharmaceuticaltreatment of chronic lymphocytic leukemia andacute myeloid leukemia. Expert Rev Hematol2022;15:833-847. https://doi.org/10.1080/17474086.2022.2125376.

  9. Tallman MS, Wang ES, Altman JK, AppelbaumFR, Bhatt VR, Bixby D, et al. Acute myeloidleukemia, version 3.2019, NCCN ClinicalPractice Guidelines in Oncology. J Natl ComprCanc Netw 2019;17:721-749. https://doi.org/10.6004/jnccn.2019.0028.

  10. Sekeres MA, Guyatt G, Abel G, Alibhai S, AltmanJK, Buckstein R, et al. American Society ofHematology 2020 guidelines for treating newlydiagnosed acute myeloid leukemia in olderadults. Blood Adv 2020;4:3528-3549. https://doi.org/10.1182/bloodadvances.2020001920.

  11. Jaime-Pérez JC, Ramos-Dávila EM,Picón-Galindo E, Jiménez-Castillo RA, LeónAG, Gómez-Almaguer D. Outcomes andsurvival predictors of Latin American olderadults with acute myeloid leukemia: Datafrom a single center. Hematol Transfus CellTher 2022;25:S2531-1379(2522)00010-00014.https://doi.org/10.1016/j.htct.2022.01.003.

  12. Griffiths EA, Carraway HE, Chandhok NS,Prebet T. Advances in non-intensive chemotherapytreatment options for adults diagnosedwith acute myeloid leukemia. Leuk Res2020;91:106339. https://doi.org/10.1016/j.leukres.2020.106339.

  13. Döhner H, Estey E, Grimwade D, Amadori S,Appelbaum FR, Büchner T, et al. Diagnosisand management of AML in adults: 2017 ELNrecommendations from an international expertpanel. Blood 2017;129:424-447. https://doi.org/10.1182/blood-2016-08-733196.

  14. Wei AH, Montesinos P, Ivanov V, DiNardoCD, Novak J, Laribi K, et al. Venetoclaxplus LDAC for newly diagnosed AML ineligiblefor intensive chemotherapy: a phase 3randomized placebo-controlled trial. Blood2020;135:2137-2145. https://doi.org/10.1182/blood.2020004856.

  15. Wei AH, Strickland SA, Hou JZ, Fiedler W,Lin TL, Walter RB, et al. Venetoclax combinedwith low-dose cytarabine for previously untreatedpatients with acute myeloid leukemia:Results from a phase Ib/II study. J Clin Oncol2019;37:1277-1284. https://doi.org/10.1200/jco.18.01600.

  16. Abbvie Inc. Prescribing Information, VENCLEXTA® (venetoclax tablets) Approved byU.S. Food and Drug Administration. Illinois,USA: Abbvie Inc.; 2019. Available from https://www.accessdata.fda.gov/drugsatfda_docs/label/2019/208573s013lbl.pdf

  17. Jaime-Pérez JC, Brito-Ramirez AS, Pinzon-UrestiMA, Gutiérrez-Aguirre H, Cantú-RodríguezOG, Herrera-Garza JL, et al. Characteristicsand clinical evolution of patients with acutemyeloblastic leukemia in northeast Mexico: aneight-year experience at a university hospital.Acta Haematol 2014;132:144-151. https://doi.org/10.1159/000356794.

  18. Padilha SL, Souza EJ, Matos MC, Domino NR.Acute myeloid leukemia: survival analysis of patientsat a university hospital of Paraná. Rev BrasHematol Hemoter 2015;37:21-27. https://doi.org/10.1016/j.bjhh.2014.11.008.

  19. Meillon-Garcia LA, Demichelis-Gómez R.Access to therapy for acute myeloid leukemiain the developing world: Barriers and solutions.Curr Oncol Rep 2020;22:125. https://doi.org/10.1007/s11912-020-00987-8.

  20. Vaughn JE, Shankaran V, Walter RB. Trends inclinical benefits and costs of novel therapeuticsin aml: At what price does progress come? CurrHematol Malig Rep 2019;14:171-178. https://doi.org/10.1007/s11899-019-00510-2.

  21. Medeiros BC, Pandya BJ, Hadfield A, Pike J,Wilson S, Mueller C, et al. Treatment patterns inpatients with acute myeloid leukemia in the UnitedStates: a cross-sectional, real-world survey.Curr Med Res Opin 2019;35:927-935. https://doi.org/10.1080/03007995.2019.1578152.

  22. Zeidan AM, Wang R, Wang X, Shallis RM,Podoltsev NA, Bewersdorf JP, et al. Clinicaloutcomes of older patients with AML receivinghypomethylating agents: a large population-based study in the United States. BloodAdvances 2020;4:2192-2201. https://doi.org/10.1182/bloodadvances.2020001779.

  23. DiNardo CD, Pratz KW, Letai A, Jonas BA, WeiAH, Thirman M, et al. Safety and preliminaryefficacy of venetoclax with decitabine or azacitidinein elderly patients with previously untreatedacute myeloid leukaemia: a non-randomised,open-label, phase 1b study. The Lancet Oncology2018;19:216-228. https://doi.org/10.1016/S1470-2045(18)30010-X.

  24. Ma E, Bonthapally V, Chawla A, Lefebvre P,Swords R, Lafeuille MH, et al. An evaluationof treatment patterns and outcomes in elderlypatients newly diagnosed with acute myeloidleukemia: A retrospective analysis of electronicmedical records from US communityoncology practices. Clin Lymphoma MyelomaLeuk 2016;16:625-636.e623. https://doi.org/10.1016/j.clml.2016.08.006.

  25. Rodrigues AL, do Nascimento DM, de LimaJM, Reis ML, Leão LB, Azevedo MC, et al.Safety and feasibility of outpatient high dosecytarabine for acute myeloid leukemia inthe Brazilian Amazon. Int J Hematol OncolStem Cell Res 2020;14:151-156. https://doi.org/10.18502/ijhoscr.v14i3.3722.

  26. Silveira DR, Coelho-Silva JL, Silva WF, VallanceG, Pereira-Martins DA, Madeira MI, etal. A multicenter comparative acute myeloid leukemiastudy: can we explain the differences inthe outcomes in resource-constrained settings?Leuk Lymphoma 2021;62:147-157. https://doi.org/10.1080/10428194.2020.1827252.

  27. Díaz-Correa LM, Madrid-Muñoz CA, Combariza-Vallejo JF, Gálvez-Cárdenas KM,Olaya-Colorado V, Donado-Gómez JH.Supervivencia de los pacientes adultos conleucemia mieloide aguda en el departamentode hematología del Hospital Pablo TobónUribe entre los años 2004 y 2010. RevCol Hematol Oncol 2017;4:40. https://doi.org/10.51643/22562915.236.

  28. Lovato PE. Leucemia mieloide aguda en adultos:Estudio comparativo sobre tratamiento ypronóstico por grupos etarios. Rev Med Hered2015;26:160-166.

  29. Al-kassab-Córdova A, Lachira-YparraguirreL, Sandival-Ampuero G, Roque K, OrtegaE, Lozano-Ballena S, et al. Incidence andoutcome of acute myeloid leukemia in Peru:An 11-year single center experience. Blood2020;136:28-29. https://doi.org/10.1182/blood-2020-143373.

  30. Smith BD, Beach CL, Mahmoud D, Weber L,Henk HJ. Survival and hospitalization amongpatients with acute myeloid leukemia treatedwith azacitidine or decitabine in a largemanaged care population: a real-world, retrospective,claims-based, comparative analysis.Exp Hematol Oncol 2014;3:10. https://doi.org/10.1186/2162-3619-3-10.

  31. Kumar AJ, Henzer T, Rodday AM, ParsonsSK. Risk factors for length of stay and chargeper day differ between older and youngerhospitalized patients with AML. Cancer Med2018;7:2744-2752. https://doi.org/10.1002/cam4.1492.

  32. Dombret H, Seymour JF, Butrym A, WierzbowskaA, Selleslag D, Jang JH, et al. Internationalphase 3 study of azacitidine vs conventionalcare regimens in older patients withnewly diagnosed AML with >30% blasts. Blood2015;126:291-299. https://doi.org/10.1182/blood-2015-01-621664.

  33. Kanakasetty GB, Lakshmaiah KC, DasappaL, Jacob LA, Suresh-Babu MC, Lokesh KN, etal. Treatment patterns and comparative analysisof non-intensive regimens in elderly acutemyeloid leukemia patients-a real-world experiencefrom India. Ann Hematol 2019;98:881-888. https://doi.org/10.1007/s00277-019-03600-6.

  34. Heiblig M, Le Jeune C, Elhamri M, Balsat M,Tigaud I, Plesa A, et al. Treatment patterns andcomparative effectiveness in elderly acute myeloidleukemia patients (age 70 years or older):the Lyon-university hospital experience. LeukLymphoma 2017;58:110-117. https://doi.org/10.1080/10428194.2016.1180688.

  35. Fenaux P, Mufti GJ, Hellstrom-Lindberg E,Santini V, Finelli C, Giagounidis A, et al. Efficacyof azacitidine compared with that ofconventional care regimens in the treatmentof higher-risk myelodysplastic syndromes:a randomised, open-label, phase III study.Lancet Oncol 2009;10:223-232. https://doi.org/10.1016/s1470-2045(09)70003-8.

  36. Kantarjian HM, Thomas XG, DmoszynskaA, Wierzbowska A, Mazur G, Mayer J,et al. Multicenter, randomized, open-label,phase III trial of decitabine versus patientchoice, with physician advice, of either supportivecare or low-dose cytarabine for thetreatment of older patients with newly diagnosedacute myeloid leukemia. J ClinOncol 2012;30:2670-2677. https://doi.org/10.1200/jco.2011.38.9429.

  37. Ministerio de Salud. Guía de Práctica Clínica.Leucemia mieloide aguda. Lima, Perú: InstitutoNacional de Enfermedades Neoplásicas;2011. Available from https://www.inen.sld.pe/portal/documentos/pdf/normas_tecnicas/2011/20102011_LEUCEMIA_MIELOIDE_AGUDA.pdf.

  38. Ministerio de Salud y Protección Social. Guíade práctica clínica (GPC) para la detección,tratamiento y seguimiento de leucemias linfoblásticay mieloide en población mayor de 18años. Guía No. GPC 2017-34. Bogotá D.C., Colombia:Ministerio de Salud y Protección Social;2017. Available from http://gpc.minsalud.gov.co/gpc_sites/Repositorio/Conv_563/GPC_Leucemia_Mayores_18a%C3%B1os/GPC_Leucemias.pdf.

  39. Qin Y, Kuang P, Liu T. Venetoclax combinedwith hypomethylating agents or low-dosecytarabine as induction chemotherapy forpatients with untreated acute myeloid leukemiaineligible for intensive chemotherapy:a systematic review and meta-analysis.Clin Exp Med 2022;23:219-222. https://doi.org/10.1007/s10238-021-00784-y.




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