What is the efficacy of decitabine for the treatment of acute myeloid leukemia (AML) in elderly patients?

Updated: May 26, 2020
  • Author: Karen Seiter, MD; Chief Editor: Emmanuel C Besa, MD  more...
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Answer

A systematic review and meta-analysis by He at al of nine published studies that enrolled 718 elderly AML patients concluded that decitabine is an effective and well-tolerated therapeutic alternative with acceptable side effects in this patient population. [68] Pooled estimates (and 95% confidence index) were as follows:

  • Complete remission (CR) 27% (19%-36%)
  • Overall response (OR) 37% (28%-47%)
  • Overall survival 8.09 months (5.77-10.41 mos)
  • Early death: 7% (2%-11%) within 30 days, 17% (11%-22%) within 60 days

A meta-analysis by Bian et al of 38 studies (3298 AML patients) in elderly patients with AML compared decitabine with several traditional chemotherapy regimens, including intensive therapy and low-dose cytarabine and found that the response rate to decitabine was better than those observed with other treatments, albeit with similar rates of infection and early death. Decitabine combined with other regimens achieved a CR rate of 46% and an OR rate of  75%. [69]

A retrospective single-institution study by Talati et al of survival outcomes in 980 elderly (≥70 years) AML concluded that hypomethylating agents (ie, azacytidine, decitabine) provided a significant survival benefit, compared with high-intensity, low-intensity, or supportive care. [70] Median OS rates were as follows:

  • Hypomethylating agent: 14.4 months
  • High-intensity therapy (daunorubicin/cytarabine or equivalent): 10.8 months
  • Low-intensity therapy (low-dose cytarabine or similar without hypomethylating agents): 5.9 months
  • Supportive care (including hydroxyurea): 2.1 months

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