Originally published as JCO Early Release 10.1200/JCO.2008.21.0674 on August 31 2009

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Acute Myeloid Leukemia With Translocation (8;21) or Inversion (16) in Elderly Patients Treated With Conventional Chemotherapy: A Collaborative Study of the French CBF-AML Intergroup

From the Institut Paoli Calmettes, Marseille; Hopital Saint Louis, Paris; Centre Hospitalier Universitaire (CHU) Purpan, Toulouse; Hopital Edouard Herriot, Lyon; CHU Nantes, Nantes; Departement Cancerologie et Hematologie CHU Grenoble, Grenoble; Hopital Haut-Leveque, Pessac; Centre Hospitalier Regional Universitaire de Lilles, Lilles; Hopital de Brabois, Nancy; Groupe Francophone des Myélodysplasies, Bobigny; CHU Brest, Brest; Centre Hospitalier de Versailles, Versailles; Institut de Cancérologie de la Loire, Saint Etienne; CHU Angers, Angers; and Clinical Investigation Centre INSERM 802, Poitiers, France.

Corresponding author: Norbert Vey, MD, Département d'Onco-Hématologie, Institut Paoli-Calmettes, 232 Blvd Sainte Marguerite, 13009 Marseille, France; e-mail: veyn{at}marseille.fnclcc.fr.

Purpose Acute myeloid leukemia (AML) with translocation (t) (8;21) or inversion (inv) (16) is associated with a favorable prognosis when treated with intensive chemotherapy. In elderly patients, these AML types are rare, and intensive treatments are much less tolerated. We conducted a retrospective study to evaluate the characteristics and outcome of AML with t(8;21) or inv(16) in the elderly.

Patients and Methods Patients with t(8;21) or inv(16) AML who were age 60 years or older and who received at least one course of induction chemotherapy were included. Postremission therapy consisted of low-dose maintenance chemotherapy (n = 72) or intensive consolidation (n = 56).

Results A total of 147 patients were analyzed. The median age was 67 years. Sixty patients had t(8;21), and 87 patients had inv(16). A total of 129 patients achieved complete response (CR) after one or two induction courses (ie, 88% CR rate), and 15 patients (10%) died early (ie, during the 8 weeks after induction). During a median follow-up of 48 months, the 5-year probabilities of overall survival (OS) and leukemia-free survival (LFS) were 31% and 27%, respectively. Multivariate analysis showed a negative impact of high WBC, impaired performance status, and deletion (9q) on OS and LFS. Administration of intensive consolidation was associated with better LFS only in patients with t(8;21). In addition, the need for critical care during induction independently predicted lower LFS.

Conclusion Because of a high CR rate, induction chemotherapy should be considered systematically for elderly patients who have AML with t(8;21) or inv(16). The high risk of relapse suggests that alternative strategies of postremission therapy are warranted.

Written on behalf of the Acute Leukemia French Association, Groupe Ouest-Est des leucémies et autres maladies du sang (GOELAMS), and Core Binding Factor Acute Myeloid Leukemia (CBF AML) intergroup.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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