TY - JOUR
T1 - Multivariate and subgroup analyses of a randomized, multinational, phase 3 trial of decitabine vs treatment choice of supportive care or cytarabine in older patients with newly diagnosed acute myeloid leukemia and poor- or intermediate-risk cytogenetics
AU - Mayer, Jiří
AU - Arthur, Christopher
AU - Delaunay, Jacques
AU - Mazur, Grzegorz
AU - Thomas, Xavier G.
AU - Wierzbowska, Agnieszka
AU - Ravandi, Farhad
AU - Berrak, Erhan
AU - Jones, Mark
AU - Li, Yuhan
AU - Kantarjian, Hagop M.
N1 - Funding Information:
JM and HMK have received research funding from Eisai Inc. JM has served as a consultant, advisory committee member, and member of the board of directors for Eisai Inc. JD has served as a remunerated consultant for Novartis and Genzyme. FR has received research funding and honoraria from Celgene and from Eisai Inc., and has received honoraria from Johnson & Johnson. PT, MJ, and YL are employees of Eisai Inc. CA, GM, XGT, and AW declare that they have no conflicts of interest. No author received an honorarium or other form of financial support related to the development of this manuscript.
PY - 2014/2/6
Y1 - 2014/2/6
N2 - Background: Compared with younger patients, older adults with acute myeloid leukemia (AML) generally have poorer survival outcomes and less benefit from clinical trials. A recent phase 3 trial demonstrated a trend toward improved overall survival (OS) with decitabine, a hypomethylating agent, compared with treatment choice of either cytarabine or supportive care (7.7 months, 95% CI: 6.2-9.2 vs 5.0 months, 95% CI: 4.3-6.3, respectively) in older adults with newly diagnosed AML. The current analyses investigated prognostic factors for outcomes in this trial and examined OS and responses in prespecified subgroups.Methods: A multivariate Cox proportional hazards model was used to investigate effects of demographic and baseline characteristics, including age, sex, cytogenetic risk, AML type, ECOG Performance Status, geographic region, bone marrow blasts, platelets, and white blood cells on OS, based on mature data. Similar analyses were conducted with a logistic regression model to predict response rates. Prespecified subgroup analyses were performed for OS and response rates, also using mature data.Results: Patient characteristics that appeared to negatively influence OS included more advanced age (hazard ratio [HR] 1.560 for ≥75 vs <70 years; p = 0.0010), poorer performance status at baseline (HR 0.771 for 0 or 1 vs 2; p = 0.0321), poor cytogenetics (HR 0.699 for intermediate vs poor; p = 0.0010), higher bone marrow blast counts (HR 1.355 for >50% vs ≤50%; p = 0.0045), low baseline platelet counts (HR 0.775 for each additional 100 × 109/L; p = 0.0015), and high white blood cell counts (HR 1.256 for each additional 25 × 109/L; p = 0.0151). Regarding geographic regions, patients from Western Europe had the longest median OS. Response rates favored decitabine for all subgroups investigated, including patients ≥75 years (odds ratio 5.94, p = 0.0006).Conclusion: Response to decitabine in AML is associated with known prognostic factors related to both patient demographics and disease characteristics.Trial registration: ClinicalTrials.gov identifier NCT00260832.
AB - Background: Compared with younger patients, older adults with acute myeloid leukemia (AML) generally have poorer survival outcomes and less benefit from clinical trials. A recent phase 3 trial demonstrated a trend toward improved overall survival (OS) with decitabine, a hypomethylating agent, compared with treatment choice of either cytarabine or supportive care (7.7 months, 95% CI: 6.2-9.2 vs 5.0 months, 95% CI: 4.3-6.3, respectively) in older adults with newly diagnosed AML. The current analyses investigated prognostic factors for outcomes in this trial and examined OS and responses in prespecified subgroups.Methods: A multivariate Cox proportional hazards model was used to investigate effects of demographic and baseline characteristics, including age, sex, cytogenetic risk, AML type, ECOG Performance Status, geographic region, bone marrow blasts, platelets, and white blood cells on OS, based on mature data. Similar analyses were conducted with a logistic regression model to predict response rates. Prespecified subgroup analyses were performed for OS and response rates, also using mature data.Results: Patient characteristics that appeared to negatively influence OS included more advanced age (hazard ratio [HR] 1.560 for ≥75 vs <70 years; p = 0.0010), poorer performance status at baseline (HR 0.771 for 0 or 1 vs 2; p = 0.0321), poor cytogenetics (HR 0.699 for intermediate vs poor; p = 0.0010), higher bone marrow blast counts (HR 1.355 for >50% vs ≤50%; p = 0.0045), low baseline platelet counts (HR 0.775 for each additional 100 × 109/L; p = 0.0015), and high white blood cell counts (HR 1.256 for each additional 25 × 109/L; p = 0.0151). Regarding geographic regions, patients from Western Europe had the longest median OS. Response rates favored decitabine for all subgroups investigated, including patients ≥75 years (odds ratio 5.94, p = 0.0006).Conclusion: Response to decitabine in AML is associated with known prognostic factors related to both patient demographics and disease characteristics.Trial registration: ClinicalTrials.gov identifier NCT00260832.
KW - Acute Myelocytic Leukemia
KW - Decitabine
KW - Elderly
KW - Treatment
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U2 - 10.1186/1471-2407-14-69
DO - 10.1186/1471-2407-14-69
M3 - Article
C2 - 24498872
AN - SCOPUS:84893204483
SN - 1471-2407
VL - 14
JO - BMC cancer
JF - BMC cancer
IS - 1
M1 - 69
ER -