Yazarlar : Burnett AK, Russell NH, Hunter AE, Milligan D, Knapper S, Wheatley K, Yin J, McMullin MF, Ali S, Bowen D, Hills RK.

Konu : Geriyatrik Hematoloji

Literatür İçeriği : Better treatment is required for older patients with acute myeloid leukaemia (AML) not considered fit for intensive chemotherapy. We report a randomised comparison of Low Dose Ara-C (LDAC) versus the novel nucleoside, Clofarabine, in untreated older patients with AML and high risk Myelodysplastic Syndrome (MDS). Four hundred and six patients with de novo (62%), secondary disease (24%) or high risk MDS (>10%marrow blasts)(15%), median age 74 years, were randomised to LDAC 20mg bid for 10 days every 6 weeks or clofarabine 20mg/m² days 1-5, both for up to 4 courses. These patients had more adverse demographics than contemporaneous intensively treated patients. The overall remission rate was 28% and 2-year survival was 13%. Clofarabine significantly improved complete remission: 22% vs 12% (HR 0.47(0.28-0.79); p=0.005) and overall response: 38% vs 19% (HR 0.41 (0.26-0.62); p=<0.0001), but there was no difference in overall survival, explained by poorer survival in the clofarabine patients who did not gain CR and also following relapse. Clofarabine was more myelosuppressive and required more supportive care. Although clofarabine doubled remission rates, overall survival was not improved overall or in any subgroup. The treatment of patients of the type treated here remains a major unmet need. (Trial registered with ID: ISRCTN 11036523).

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