A group of researchers from China determine if administering HLA-mismatched microtransplants is beneficial to elderly patients with acute myeloid leukemia.
Acute myeloid leukemia (AML) is known to have a poor prognosis among patients older than 60 years old due to intrinsic resistance to chemotherapeutic drugs and different physiologic characteristics compared to a younger population. Although HLA-mismatched microtransplants can be done among this age group, there are only a few studies published evaluating its safety and effectiveness.
In an article recently published in JAMA Oncology, a group of researchers from China did a study to determine different outcomes of acute myeloid leukemia (AML) patients receiving HLA-mismatched microtransplants across different age groups. A total of 185 patients diagnosed with AML were included in the study. Participants were divided into the following age groups: 60-64 years, 65-69 years, 70-74 years, and 75-85 years. Induction chemotherapy and post-remission therapy with cytarabine hydrochloride with or without anthracycline, followed by highly HLA-mismatched related or fully unrelated donor cell infusion were administered to all participants. Complete remission rates, leukemia-free survival, and overall survival rates were then determined as primary outcomes of the study. Hematopoietic recovery, graft-vs-host disease relapse rate, nonrelapse mortality, and other treatment-related toxicities were also measured.
The results of the study show that there was no significant difference in the overall complete remission rate among different age groups. One year overall survival rates were higher among the first three age groups compared to the last age group. Two-year overall survival rates were observed to be higher among the first two age groups. The one-year cumulative incidences of nonrelapse mortality were 10.2%, 0%, 3.4%, and 26%, respectively. The one-year cumulative incidence of nonrelapse mortality among all patients was 8.1%.
Overall, HLA-mismatched microtransplants can improve clinical outcomes in AML patients who are older than 60 years. This important study indicates that microtransplants provide a safe and effective therapy for elderly patients with leukemia.
Written by Karla Sevilla
Source: Guo, M., et al. (2017). HLA-mismatched micro-transplant in older patients newly diagnosed with acute myeloid leukemia: results from the microtransplantation interest group. JAMA Oncology. doi: 10.1001/jamaoncol.2017.2656