ISSN: 0443-511
e-ISSN: 2448-5667
Usuario/a
Idioma
Herramientas del artículo
Envíe este artículo por correo electrónico (Inicie sesión)
Enviar un correo electrónico al autor/a (Inicie sesión)
Tamaño de fuente

Notificaciones

Open Journal Systems

Quimioterapia intensa frente a quimioterapia paliativa en pacientes con leucemia mieloblástica mayores de 60 años

Jesús Medrano-Contreras, Juan O Talavera, Susana Guerrero-Rivera, Guillermo Rodolfo Gutiérrez-Espíndola, Cynthia Gómez-Cortés, Juan Fernando Pérez-Rocha, Eduardo Terreros-Muñoz, Luis Antonio Meillón-García

Resumen


Introducción: el tratamiento con quimioterapia intensa (QTI) en pacientes con leucemia mieloblástica (LMA) mayores de 60 años es controversial. En el presente estudio se evaluó la remisión completa y la supervivencia global de pacientes con LMA mayores de 60 años, tratados con QTI o quimioterapia paliativa. 

Métodos: los pacientes con adecuada función orgánica y ECOG ≤ 2 recibieron QTI a base de citarabina por cinco o siete días más un antracíclico por tres días y terapia de soporte. En caso de lograr remisión completa de la leucemia recibieron uno o dos ciclos de consolidación con citarabina. El tratamiento paliativo consistió en medidas de soporte o quimioterapia oral o intravenosa en dosis bajas. 

Resultados: del grupo de QTI siete pacientes alcanzaron remisión completa, comparados con uno del grupo de quimioterapia paliativa. La supervivencia global fue de 13.25 meses para los pacientes con QTI y de 3.35 meses para los pacientes de quimioterapia paliativa (p < 0.05). 

Conclusión: es posible que los pacientes con LMA mayores de 60 años de edad se beneficien de recibir QTI, comparada con la quimioterapia paliativa.


Palabras clave


Leucemia mieloide aguda; Anciano; Quimioterapia

Texto completo:

PDF HTML PubMed HTML (English)

Referencias


Brinker H. Population-based age and sex specific incidence rates in the four main types of leukemia. Scand J Hematol. 1982;29:241-9.

 

Sekeres MA, Stone RM. The challenge of acute myeloid leukemia in older patients. Curr Opin Oncol. 2002;14:24-30.

 

Bishop JF, Matthews JP, Young GA, Szer J, Gillett A, Joshua D, et al. A randomized study of a high dose cytarabine in induction in acute myeloid leukemia. Blood. 1996;87:1710-7.

 

Büchner T, Hiddemann W, Wörmann B, Löffler H, Gassmann W, Haferlach T, et al. Double induction strategy for acute myeloid leukemia: the effect of high-dose cytarabine with mitoxantrone instead of standart-dose with daunorrubicin and 6-thioguanine. A randomized trial by the German AML cooperative group. Blood. 1999;93:4116-24.

 

Rowe JM. Treatment of acute myelogenous leukemia in older adults. Leukemia. 2000;14:480-7. Disponible en http://www.nature.com/leu/journal/v14/n3/full/2401539a.html

 

Büchner T, Berder WE, Haferlach T, Schinittger S, Miller-Tidow C, Braess J, et al. Age related risk profile and chemotherapy dose response in acute myeloid leukemia: a study by the German Acute Myeloid Leukemia Cooperative Group. J Clin Oncol. 2009;27:61-9.

 

Frohling S, Schlenk RF, Kayser S. Morhardt M, Banner A, Dohner H. Cytogenetics and age are major determinants of outcome in intensively treated acute myeloid leukemia patients older than 60 years: results from AMLSG trial AML HD98-B. Blood. 2006;108(10):3280-8.

 

Leith CP, Kopecky KJ, Godwin J, McConell T, Slovac ML, Chen IM. Acute leukemia myeloid in the elderly: Assessment of the multidrug resistance (MDR1) and cytogenetic distinguishes biologic subgroups with remarkably distinct responses to standard chemotherapy. A southwest Oncology Group Study. Blood. 1997;89:3323-9.

 

Hiddemann W, Kern W, Schoch C, Fonatsch C, Heinecke A, Wormann B, et al. Management of acute myeloid leukemia in elderly patients. J Clin Oncol. 1999;17:3569-76.

 

Mauritzson N, Johansson B, Albin M, Rylander I, Billstrom R, Ahlgren T. Survival time in a population-based series of adult acute myeloid leukemia: the prognostic impact of Karyotype during the time period 1976-1993. Leukemia. 2000;14:1039-43.

 

Hestey EH. Prognostic factors in acute myelogenous leukemia. Leukemia. 2001;15:670-2.

 

Anderson JE, Kopecky KJ, Willman CL, Head D, O’Donell MR, Luthardt FW, et al. Outcome after induction chemotherapy for older patients with acute myeloid leukemia is not improved with mitoxantrone and etoposide compared to cytarabine and daunorubicin: a Southwest Oncology Group study. Blood. 2002;100:3869-76.

 

Lowenberg B, Suciu S, Archimbaud E, Ossenkoppele G, Verhoef GE, Vellenga E, et al. Use of recombinant granulocyte-macrophage colony-stimulating factor during and after remission induction chemotherapy in patient aged 61 years and older with acute myeloid leukemia: a final report of AML-11; a phase III randomized study of the Leukemia Cooperative Group of European Organization for the Research and Treatment of Cancer and the Dutch Belgian Hemato-Oncology Cooperative Group. Blood. 1997;90:2952-61.

 

Lowenberg B, Suciu S, Archimbaud E, Haak H, Stryckmans P, de Cataldo R. Mitoxantrone versus daunorubicin in induction-consolidation chemotherapy. The value of low-dose cytarabine for maintenance of remission, and an assessment of prognostic factors in acute myeloid leukemia in the elderly: final report. European Organization for the Research and Treatment of Cancer and the Dutch-Belgian Hemato-Oncology Cooperative Hovon Group.. J Clin Oncol. 1998;16:872-81.

 

Yoshida S, Kuriyama K, Miyazaki Y, Taguchi J, Fukushima T, Honda M, et al. De novo acute myeloid leukemia in the elderly; a consistent fraction of long-term survivors by standard-dose chemotherapy. Leuk Res. 2001 Jan;25(1):33-38.

 

López A, De la Rubia J, Martín G, Martínez J, Cervera J, Jarque I. Recent improvements in outcome for elderly patient with de novo acute myeloblastic leukemia. Leuk Res. 2001;25:685-92.

 

Tilly H, Castaigne S, Bordessoule D, Casassus P, Le Prisé PY, Tertian G, et al. Low-dose cytarabine vs. intensive chemotherapy in the treatment of acute nonlimphocytic leukemia in the elderly. J Clin Oncol. 1990;8(2):272-9.

 

Stone RM, Berg DT, George SL, Dodge RK, Paciucci PA, Schulman P, et al. Granulocyte-macrophage colony-stimulating factor after initial chemotherapy for elderly patients with primary acute myelogenous leukemia. Cancer and Leukemia Group B. N Engl J Med. 1995 Jun 22;332(25):1671-7.

 

Pulsoni A, Pagano L, Latagliata R, Casini M, Cerri R, Crugnola M, et al. Survival of elderly patients with acute myeloid leukemia. Haematologica. 2004 Mar;89(3):296-302.

 

Rodríguez JN, Fernández-Jurado A, Martino ML, Dieguez JC, Moreno MV, Quesada JA, et al. Leucemia mieloide aguda en mayores de 70 años. Experiencia utilizando tratamiento con ara-C a bajas dosis. Sangre (Barc). 1998;43(1):35-39.

 

Doubek M, Palasek I, Brychtova Y, Buchtova I, Mayer J. Acute myeloid leukemia treatment in patient over 60 years of age. Comparison of symptomatic, palliative, and aggressive therapy. Neoplasma. 2005;52(5):411-4.

 

Juliusson G, Antunovic P, Derolf A, Lehmann S, Möllgård L, Stockelberg D, et al. Age and acute myeloid leukemia: real data on decision to treat and outcomes from the Swedish Acute Leukemia Registry. Blood. 2009 Apr 30;113(18):4179-87. doi: 10.1182/blood-2008-07-172007.

 

Röllig C, Thiede C, Gramatzki M, Aulitzky W, Bodenstein H, Bornhäuser M, et al. A novel prognostic model in erderly patients with acute myeloid leukemia: results of 909 patients entered into the prospective AML 96 trial. Blood. 2010 Aug 12;116(6):971-8. doi: 10.1182/blood-2010-01-267302.

 

Bennett JM, Catovsky D, Daniel MT, Flandrin G, Galton DA, Gralnick HR, et al. Proposals for the classification of the acute leukemia. Br J Haematol. 1976 Aug;33(4):451-8.

 

Cheson BD, Cassileth PA, Head DR, Schiffer CA, Bennett JM, Bloomfield CD, et al. Report of the National Cancer Institute-sponsored workshop on definitions of diagnosis and response in acute leukemia. J Clin Oncol. 1990;8:813-19.

 

Buitrón-Santiago N, Arteaga-Ortíz L, Rosas-López A, Aguayo A, López-Karpovitch X, Crespo-Solís E. Leucemia mieloide aguda en adultos: experiencia del Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán de 2003 a 2008. Rev Inv Clin. 2010;62:100-8.

 

Lobato-Mendizábal E, Ruíz-Argüelles GJ, Labardini-Méndez J, Gómez-Almaguer D, Ganci-Cerrud G, Lozano-de la Vega A. Comparación de 2 protocolos de quimioterapia en adultos con leucemia mieloblastica aguda. Resultados del Instituto Nacional de la Nutrición Salvador Zubirán grupo cooperativo. Rev Inv Clin. 1992;44:63-9.

 

Mohamedali H, Breunis H, Timilshina N, Brandwein JM, Gupta V, Minden MD, et al. Older age is associated with similar quality of life and physical function compared to younger age during intensive chemotherapy for acute myeloid leukemia. Leuk Res. 2012:1241-8.

 

DeLima M, Ghaddar H, Pierce S, Estey E. Treatment of newly-diagnosed acute myelogenous in patient aged 80 years and above. Br J Hematol. 1996;93:89-95.

 

Lowenberg B. Managing therapy in older patient with acute myeloid leukaemia. Sem Hematol. 2001;38:10-16.

 

Grimwade D, Walker H, Harrison G, Oliver F, Chatters S, Harrison Ch, et al. The predictive value of hierarchical cytogenetic classification in older adults with acute myeloid leukemia (AML): analysis of 1065 patients entered into the United Kingdom Medical Research Council AML 11 trial. Blood. 2001; 98:1312-20.

 

Ferrara F, Pinto A. Acute Myeloid Leukemia in the elderly: current therapeutic results and perspectives for clinical research. Rev Recent Clin Trials. 2007;2:33-41.


Enlaces refback

  • No hay ningún enlace refback.