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BCL-2 Expression in AML Patients over 65 Years: Impact on Outcomes across Different Therapeutic Strategies

BCL-2 overexpression has been associated with resistance to chemotherapy and reduced survival in acute myeloid leukemia (AML), but few data are available in elderly patients, a subset accounting for majority of AML cases and with dismal prognosis. We retrospectively analyzed 113 AML patients aged ≥6...

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Autores principales: Tiribelli, Mario, Michelutti, Angela, Cavallin, Margherita, Di Giusto, Sara, Simeone, Erica, Fanin, Renato, Damiani, Daniela
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8585096/
https://www.ncbi.nlm.nih.gov/pubmed/34768616
http://dx.doi.org/10.3390/jcm10215096
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author Tiribelli, Mario
Michelutti, Angela
Cavallin, Margherita
Di Giusto, Sara
Simeone, Erica
Fanin, Renato
Damiani, Daniela
author_facet Tiribelli, Mario
Michelutti, Angela
Cavallin, Margherita
Di Giusto, Sara
Simeone, Erica
Fanin, Renato
Damiani, Daniela
author_sort Tiribelli, Mario
collection PubMed
description BCL-2 overexpression has been associated with resistance to chemotherapy and reduced survival in acute myeloid leukemia (AML), but few data are available in elderly patients, a subset accounting for majority of AML cases and with dismal prognosis. We retrospectively analyzed 113 AML patients aged ≥65 years treated with 3 + 7 chemotherapy (n = 51) or hypomethylating agents (HMAs) (n = 62), evaluating the role of BCL-2 expression on complete remission (CR) and overall survival (OS). BCL-2 was expressed in 81 patients (72%), more frequently in those with unfavorable cytogenetic-molecular risk. CR was achieved in 34.5% cases, without differences according to BCL-2 expression or induction therapy. In the whole population 1-year OS was 39%, similar in BCL-2+ and BCL-2- cases. In BCL-2 positive patients OS was superior with HMAs (56% vs. 25% with 3 + 7; p = 0.02), while no advantage for HMA was found in BCL-2 negative cases (36% vs. 27% for 3 + 7). Therapy with HMAs was the only factor associated with longer OS in BCL-2+ AML by multivariable analysis. Use of HMAs, possibly in combination with BCL-2 inhibitors, appears to be particularly appealing in BCL2+ AML, where it is associated with superior survival.
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spelling pubmed-85850962021-11-12 BCL-2 Expression in AML Patients over 65 Years: Impact on Outcomes across Different Therapeutic Strategies Tiribelli, Mario Michelutti, Angela Cavallin, Margherita Di Giusto, Sara Simeone, Erica Fanin, Renato Damiani, Daniela J Clin Med Article BCL-2 overexpression has been associated with resistance to chemotherapy and reduced survival in acute myeloid leukemia (AML), but few data are available in elderly patients, a subset accounting for majority of AML cases and with dismal prognosis. We retrospectively analyzed 113 AML patients aged ≥65 years treated with 3 + 7 chemotherapy (n = 51) or hypomethylating agents (HMAs) (n = 62), evaluating the role of BCL-2 expression on complete remission (CR) and overall survival (OS). BCL-2 was expressed in 81 patients (72%), more frequently in those with unfavorable cytogenetic-molecular risk. CR was achieved in 34.5% cases, without differences according to BCL-2 expression or induction therapy. In the whole population 1-year OS was 39%, similar in BCL-2+ and BCL-2- cases. In BCL-2 positive patients OS was superior with HMAs (56% vs. 25% with 3 + 7; p = 0.02), while no advantage for HMA was found in BCL-2 negative cases (36% vs. 27% for 3 + 7). Therapy with HMAs was the only factor associated with longer OS in BCL-2+ AML by multivariable analysis. Use of HMAs, possibly in combination with BCL-2 inhibitors, appears to be particularly appealing in BCL2+ AML, where it is associated with superior survival. MDPI 2021-10-30 /pmc/articles/PMC8585096/ /pubmed/34768616 http://dx.doi.org/10.3390/jcm10215096 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Tiribelli, Mario
Michelutti, Angela
Cavallin, Margherita
Di Giusto, Sara
Simeone, Erica
Fanin, Renato
Damiani, Daniela
BCL-2 Expression in AML Patients over 65 Years: Impact on Outcomes across Different Therapeutic Strategies
title BCL-2 Expression in AML Patients over 65 Years: Impact on Outcomes across Different Therapeutic Strategies
title_full BCL-2 Expression in AML Patients over 65 Years: Impact on Outcomes across Different Therapeutic Strategies
title_fullStr BCL-2 Expression in AML Patients over 65 Years: Impact on Outcomes across Different Therapeutic Strategies
title_full_unstemmed BCL-2 Expression in AML Patients over 65 Years: Impact on Outcomes across Different Therapeutic Strategies
title_short BCL-2 Expression in AML Patients over 65 Years: Impact on Outcomes across Different Therapeutic Strategies
title_sort bcl-2 expression in aml patients over 65 years: impact on outcomes across different therapeutic strategies
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8585096/
https://www.ncbi.nlm.nih.gov/pubmed/34768616
http://dx.doi.org/10.3390/jcm10215096
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