%0 Journal Article
%A Stahl, Maximilian
%A DeVeaux, Michelle
%A Montesinos, Pau
%A Itzykson, Raphael
%A Ritchie, Ellen K
%A Sekeres, Mikkael A
%A Barnard, John D
%A Podoltsev, Nikolai A
%A Brunner, Andrew M
%A Komrokji, Rami S
%A Bhatt, Vijaya R
%A Al-Kali, Aref
%A Cluzeau, Thomas
%A Santini, Valeria
%A Fathi, Amir T
%A Roboz, Gail J
%A Fenaux, Pierre
%A Litzow, Mark R
%A Perreault, Sarah
%A Kim, Tae Kon
%A Prebet, Thomas
%A Vey, Norbert
%A Verma, Vivek
%A Germing, Ulrich
%A Bergua, Juan Miguel
%A Serrano, Josefina
%A Gore, Steven D
%A Zeidan, Amer M
%T Hypomethylating agents in relapsed and refractory AML: outcomes and their predictors in a large international patient cohort.
%D 2018
%U http://hdl.handle.net/10668/12380
%X Although hypomethylating agents (HMAs) are frequently used in the frontline treatment of older acute myeloid leukemia (AML) patients, little is known about their effectiveness in relapsed or primary treatment-refractory (RR)-AML. Using an international multicenter retrospective database, we studied the effectiveness of HMAs in RR-AML and evaluated for predictors of response and overall survival (OS). A total of 655 patients from 12 centers received azacitidine (57%) or decitabine (43%), including 290 refractory (44%) and 365 relapsed (56%) patients. Median age at diagnosis was 65 years. Best response to HMAs was complete remission (CR; 11%) or CR with incomplete count recovery (CRi; 5.3%). Additionally, 8.5% experienced hematologic improvement. Median OS was 6.7 months (95% confidence interval, 6.1-7.3). As expected, OS differed significantly by best response, with patients achieving CR and CRi having a median OS of 25.3 and 14.6 months, respectively. In multivariate analysis, the presence of ≤5% circulating blasts and a 10-day schedule of decitabine were associated with improved response rates, whereas the presence of >5% circulating blasts and >20% bone marrow blasts were associated with decreased OS. A significant subset of RR-AML patients (16%) achieved CR/CRi with HMAs and experienced a median OS of 21 months. Outside of a clinical trial, HMAs represent a reasonable therapeutic option for some patients with RR-AML.
%K Myeloid Neoplasia
%K Clinical Trials and Observations
%K Antimetabolitos antineoplásicos
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