Decitabine Versus Intensive Chemotherapy for Elderly Patients With Newly Diagnosed Acute Myeloid Leukemia

Abstract Background Elderly patients with acute myeloid leukemia (AML) have generally had a poor prognosis with unfavorable clinical and biologic disease features. Hypomethylating agents have shown potential for treating medically unfit and elderly patients with AML. Patients and Methods We compared the outcomes of elderly patients with AML treated with decitabine and intensive chemotherapy (IC). Results The data from 107 patients with newly diagnosed AML aged ≥ 65 years were analyzed. The overall response rate was 38.6% and was significantly greater in the IC group than in the decitabine group (65.6% vs. 26.1%; P FLT3 -internal tandem duplication mutation (hazard ratio [HR], 2.637; 95% CI, 1.379-5.043; P  = .003), complex karyotype (HR, 2.513; 95% CI, 1.258-5.020; P  = .009), and peripheral blood blast percentage at diagnosis (HR, 1.983; 95% CI, 1.148-3.422; P  = .014) were analyzed as independent prognostic factors for OS. A subgroup analysis for OS showed that IC was superior to decitabine for patients with the FLT3 -internal tandem duplication mutation ( P  = .025) and poor risk cytogenetics, except for −7/del(7q) ( P  = .005), and decitabine was associated with longer OS for patients with −7/del(7q) ( P  = .077). Conclusion Decitabine showed a similar OS to IC, despite the lower response rate in patients. The clinical outcomes of specific subgroups seemed to differ with different treatment options. Optimal therapeutic approaches for elderly patients with AML should be further examined.