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Randomized trial of 10 days of decitabine ± bortezomib in untreated older patients with AML: CALGB 11002 (Alliance)

Gail J. Roboz, Sumithra J. Mandrekar, Pinkal Desai, Kristina Laumann, Alison R. Walker, Eunice S. Wang, Jonathan E. Kolitz, Bayard L. Powell, Eyal C. Attar, Wendy Stock, Clara D. Bloomfield, Jessica Kohlschmidt, Krzysztof Mrózek, Duane C. Hassane, Levi Garraway, Judit Jané-Valbuena, Michele Baltay, Adam Tracy, Guido Marcucci, Richard M. Stone and Richard A. Larson

Key Points

  • The addition of bortezomib to decitabine did not result in improved outcomes in newly diagnosed elderly patients with AML.

  • Induction with 10-day decitabine cycles resulted in higher remission rates than previous CALGB trials of newly diagnosed older AML patients.

Abstract

Novel treatment strategies are needed for older patients with acute myeloid leukemia (AML). This randomized phase 2 trial compared the efficacy and safety of 20 mg/m2 of IV decitabine on days 1 to 10 alone (arm A) with those of 1.3 mg/m2 of subcutaneous bortezomib (arm B) on days 1, 4, 8, and 11 for up to 4 10-day cycles followed by monthly 5-day cycles. Previously untreated AML patients age ≥60 years (excluding those with FLT3 mutations and favorable-risk cytogenetics) without restrictions in performance status (PS) or organ function were eligible. Median age was 72.4 years (range, 60.5-92.3 years); 31 patients (19%) had baseline PS ≥2, 35 (22%) had an antecedent hematological disorder, 58 had (39%) adverse cytogenetics, and 7 (5%) and 23 (14%) had abnormal cardiac or renal function. There were no statistically significant differences in overall survival (OS) or responses between the 2 treatment arms. The overall response rate (complete remission + complete remission with incomplete blood count recovery) was 39% (n = 64), with median OS of 9.3 months. Nineteen responders (31%) underwent allogeneic stem cell transplantation. The most common adverse event was febrile neutropenia, and there were no unexpected toxicities. Adding bortezomib to decitabine did not improve outcomes, but responses were better than those in previous trials using 5-day decitabine cycles. This trial was registered at www.clinicaltrials.gov as #NCT01420926.

  • Submitted July 16, 2018.
  • Accepted October 13, 2018.
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