Feasibility of Outpatient Consolidation Chemotherapy and Toxicity in Elderly Patients with AML.
Bibliographic record
Abstract
Abstract Abstract 1036 Poster Board I-58 Introduction: Consolidation chemotherapy is frequently administered on an outpatient basis in younger AML patients. However, the safety of this maneuver in older patients is unclear owing to increased co-morbidities and declines in performance status (PS) in these patients. Methods: 215 newly diagnosed AML patients aged >60 years were referred to Princess Margaret Hospital between 2002 and 2005. Of these, 108 received non-protocol treatments (32 non-intensive experimental therapy, 12 intensive chemotherapy on a study protocol, and 64 palliative therapy). The remaining 107 (50%) received standard induction chemotherapy with curative intent, consisting of cytarabine 100 mg/m2/day CIVI x 7 days and dauorubicin 60 mg/m2 IV daily x 3 (3+7). Patients achieving CR were eligible to receive two consolidations, with 3+7 (C#1) followed by mitoxantrone 10 mg/m2 daily x 5 plus etoposide 100 mg/m2 IV daily x 5 (C#2). All patients underwent cardiac assessment prior to each cycle with MUGA scan. If the ejection fraction (EF) dropped to < 50% or had fallen by >10%, amsacrine (100 mg/m2 IV daily x 5) was substituted for the anthracycline. Consolidation was administered on an inpatient or outpatient basis according to physician discretion. Inpatient consolidations were administered to patients judged to have significant co-morbidities and poor PS post-induction, while the remaining patients were given consolidation on an outpatient basis, with twice weekly monitoring until hematologic recovery. Oral antibiotic and antifungal prophylaxis was used. Febrile neutropenia (FN) was treated with inpatient IV broad-spectrum antibiotics. Results: The median age of patients was 68 years (range, 60-84). 59 of 107 pts (55%) achieved a CR and a further 5 patients a leukemia free state with induction chemotherapy. 55 patients achieving CR proceeded to consolidation therapy on protocol. 38/55 pts. (69%) received C#1 as outpatient; the rate of admission for FN in these patients was 45%. 39/55 pts (71%) went on to receive a second consolidation cycle. Reasons for attrition post-C#1 included medically unfit (6 pts), persistent aplasia (3) and relapse (4). 32/39 (82%) pts received C#2 as outpatient; the rate of admission for FN was 59%. There were no treatment related deaths during consolidation therapy. Among patients proceeding to consolidation, 35/55 (63%) had a significant decline in LVEF during, or at completion of, treatment: >10% drop in LVEF in 31 pts. and LVEF <50% in 17 pts (7 of these to <40%); 24/35 pts received a change in consolidation chemotherapy as a result. At a median follow-up of 11.0 months, 80/107 (75%) have died; the median overall survival (OS) was 11.4 months, 3 year OS for all patients was 20%. For those patients obtaining CR, the median relapse-free survival (RFS) was 8.4 months. There was no significant difference in RFS and OS between patients switched to amsacrine versus those receiving standard protocol (p=0.15 and 0.31 respectively). Discussion: We have demonstrated that post-remission consolidation chemotherapy can be safely administered on an outpatient basis in the majority of otherwise medically fit elderly AML patients in CR-1 using this regimen. Approximately one half will require admission for febrile neutropenia, but treatment related mortality is low. Cardiac toxicity with this anthracycline-intensive regimen is significant, and close monitoring of LV function is required. Switching anthracycline drug to amsacrine during post-remission therapy does not appear to adversely affect outcome. Disclosures: No relevant conflicts of interest to declare.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".