Feasibility of Outpatient Consolidation Chemotherapy and Toxicity in Elderly Patients with AML.

Richard Ward, BSc, MRCP, FRCPath1, Vikas Gupta, MD2, Mark D. Minden, MD, PhD3, Aaron D. Schimmer, MD, PhD4, Karen WL Yee, MD*,3, Andre Schuh, MD5, Wei Xu, PhD*,6 and Joseph Brandwein, MD7

Author address: 

1 Dept. of Medical Oncology and Hematology, Toronto, ON, Canada, 2 Division of Haematology, Princess Margaret Hospital, University of Toronto, Toronto, ON, Canada, 3 Princess Margaret Hospital, Toronto, ON, Canada, 4 Princess Margaret Hospital/

Abstract: 

Poster Board I-58 Introduction: Consolidation chemotherapy is frequently administered on an outpatient basis in younger AML patients. However, the safety of this maneuver in older patients is unclear owing to increased co-morbidities and declines in performance status (PS) in these patients. Methods: 215 newly diagnosed AML patients aged >60 years were referred to Princess Margaret Hospital between 2002 and 2005. Of these, 108 received non-protocol treatments (32 non-intensive experimental therapy, 12 intensive chemotherapy on a study protocol, and 64 palliative therapy). The remaining 107 (50%) received standard induction chemotherapy with curative intent, consisting of cytarabine 100 mg/m2/day CIVI x 7 days and dauorubicin 60 mg/m2 IV daily x 3 (3+7). Patients achieving CR were eligible to receive two consolidations, with 3+7 (C#1) followed by mitoxantrone 10 mg/m2 daily x 5 plus etoposide 100 mg/m2 IV daily x 5 (C#2). All patients underwent cardiac assessment prior to each cycle with MUGA scan. If the ejection fraction (EF) dropped to 10%, amsacrine (100 mg/m2 IV daily x 5) was substituted for the anthracycline. Consolidation was administered on an inpatient or outpatient basis according to physician discretion. Inpatient consolidations were administered to patients judged to have significant co-morbidities and poor PS post-induction, while the remaining patients were given consolidation on an outpatient basis, with twice weekly monitoring until hematologic recovery. Oral antibiotic and antifungal prophylaxis was used. Febrile neutropenia (FN) was treated with inpatient IV broad-spectrum antibiotics. Results: The median age of patients was 68 years (range, 60-84). 59 of 107 pts (55%) achieved a CR and a further 5 patients a leukemia free state with induction chemotherapy. 55 patients achieving CR proceeded to consolidation therapy on protocol. 38/55 pts. (69%) received C#1 as outpatient; the rate of admission for FN in these patients was 45%. 39/55 pts (71%) went on to receive a second consolidation cycle. Reasons for attrition post-C#1 included medically unfit (6 pts), persistent aplasia (3) and relapse (4). 32/39 (82%) pts received C#2 as outpatient; the rate of admission for FN was 59%. There were no treatment related deaths during consolidation therapy. Among patients proceeding to consolidation, 35/55 (63%) had a significant decline in LVEF during, or at completion of, treatment: >10% drop in LVEF in 31 pts. and LVEF
2009

abstract No: 

1036

Full conference title: 

51st American Society of Haematologists Annual Meeting
    • ASH 51st (2009)