{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,2]],"date-time":"2025-11-02T07:25:04Z","timestamp":1762068304292,"version":"build-2065373602"},"reference-count":33,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2022,10,6]],"date-time":"2022-10-06T00:00:00Z","timestamp":1665014400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Elderly patients represent the most challenging and hard-to-treat patient population due to dismal characteristics of the disease, such as secondary-acute myeloid leukemia (AML), enrichment of unfavorable molecular genes (TP53) and comorbidities. We conducted a multicentric retrospective study to evaluate activity and safety in a real-life setting of hypomethylating drugs (HMAs) in patients older than 75 years with AML. Between September 2010 and December 2021, 220 patients were treated, 164 (74.5%) received AZAcitidine and 56 DECitabine; most patients (57.8%), received more than four cycles of HMAs. The best response obtained was CR in 51 patients (23.2%), PR in 23 (10.5%) and SD in 45 (20.5%); overall transfusion independence was obtained in 47 patients (34%), after a median of 3.5 months. The median OS (mOs) was 8 months (95% CI 5.9\u201310.2), with 1- and 2-years OS of 39.4% (95% CI 32.7\u201346) and 17.4% (95% CI 11.7\u201323.1), respectively; similar mOS was observed according to HMA treatment (AZA 8.3 vs. DEC 7.8 months, p = 0.810). A subset of 57 long survivors (44 in AZA group and 13 in DEC group) received at least 12 cycles of HMAs, their mOS was 24.3 months. In multivariate analysis, age (\u226580), Charlson comorbidity index (\u22653), creatinine clearance and the type of best response (\u2265PR) during treatment maintained independent significance in predicting survival. Infectious complications, most frequently pneumonia (35) and septic shock (12), were lethal in 49 patients (22.2%). Our data show that HMAs have similar efficacy compared to pivotal trials and are well tolerated in a setting of very elderly patients with several co-comorbidities.<\/jats:p>","DOI":"10.3390\/cancers14194897","type":"journal-article","created":{"date-parts":[[2022,10,8]],"date-time":"2022-10-08T00:07:43Z","timestamp":1665187663000},"page":"4897","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Identification of Predictive Factors for Overall Survival and Response during Hypomethylating Treatment in Very Elderly (\u226575 Years) Acute Myeloid Leukemia Patients: A Multicenter Real-Life Experience"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6391-4406","authenticated-orcid":false,"given":"Matteo","family":"Molica","sequence":"first","affiliation":[{"name":"Hematology and Stem Cell Transplant Unit, St. Eugenio Hospital, 00144 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carla","family":"Mazzone","sequence":"additional","affiliation":[{"name":"Hematology and Stem Cell Transplant Unit, St. Eugenio Hospital, 00144 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2226-6518","authenticated-orcid":false,"given":"Pasquale","family":"Niscola","sequence":"additional","affiliation":[{"name":"Hematology and Stem Cell Transplant Unit, St. Eugenio Hospital, 00144 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ida","family":"Carmosino","sequence":"additional","affiliation":[{"name":"Hematology, Department of Translational and Precision Medicine, Policlinico Umberto I, Sapienza University, 00185 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ambra","family":"Di Veroli","sequence":"additional","affiliation":[{"name":"Hematology Division, Ospedale Belcolle, 01100 Viterbo, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cinzia","family":"De Gregoris","sequence":"additional","affiliation":[{"name":"Hematology Division, Ospedale Belcolle, 01100 Viterbo, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fabrizio","family":"Bonanni","sequence":"additional","affiliation":[{"name":"Hematology, Department of Biomedicine and Prevention, University Tor Vergata, 00133 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8196-0481","authenticated-orcid":false,"given":"Salvatore","family":"Perrone","sequence":"additional","affiliation":[{"name":"Hematology, Polo Universitario Pontino, S.M. Goretti Hospital, 04100 Latina, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Natalia","family":"Cenfra","sequence":"additional","affiliation":[{"name":"Hematology, Polo Universitario Pontino, S.M. Goretti Hospital, 04100 Latina, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luana","family":"Fianchi","sequence":"additional","affiliation":[{"name":"Institute of Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anna Lina","family":"Piccioni","sequence":"additional","affiliation":[{"name":"Hematology and Stem Cell Transplant, San Giovanni Addolorata, 00184 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antonio","family":"Spadea","sequence":"additional","affiliation":[{"name":"Hematology and Stem Cell Transplant Unit, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giovanni","family":"Luzi","sequence":"additional","affiliation":[{"name":"Hematology and Stem Cell Transplant, San Camillo Forlanini Hospital, 00152 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2606-2467","authenticated-orcid":false,"given":"Andrea","family":"Mengarelli","sequence":"additional","affiliation":[{"name":"Hematology and Stem Cell Transplant Unit, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura","family":"Cudillo","sequence":"additional","affiliation":[{"name":"Hematology and Stem Cell Transplant, San Giovanni Addolorata, 00184 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7297-4988","authenticated-orcid":false,"given":"Luca","family":"Maurillo","sequence":"additional","affiliation":[{"name":"Hematology, Department of Biomedicine and Prevention, University Tor Vergata, 00133 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8287-928X","authenticated-orcid":false,"given":"Livio","family":"Pagano","sequence":"additional","affiliation":[{"name":"Institute of Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1163-6162","authenticated-orcid":false,"given":"Massimo","family":"Breccia","sequence":"additional","affiliation":[{"name":"Hematology, Department of Translational and Precision Medicine, Policlinico Umberto I, Sapienza University, 00185 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9320-9334","authenticated-orcid":false,"given":"Luigi","family":"Rigacci","sequence":"additional","affiliation":[{"name":"Hematology and Stem Cell Transplant, San Camillo Forlanini Hospital, 00152 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paolo","family":"De Fabritiis","sequence":"additional","affiliation":[{"name":"Hematology and Stem Cell Transplant Unit, St. Eugenio Hospital, 00144 Rome, Italy"},{"name":"Hematology, Department of Biomedicine and Prevention, University Tor Vergata, 00133 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,10,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1016\/j.blre.2019.04.005","article-title":"Epidemiology of acute myeloid leukemia: Recent progress and enduring challenges","volume":"36","author":"Shallis","year":"2019","journal-title":"Blood Rev."},{"key":"ref_2","first-page":"472","article-title":"Molecular and genomic landscapes in secondary & therapy related acute myeloid leukemia","volume":"11","author":"Goel","year":"2021","journal-title":"Am J Blood Res."},{"unstructured":"Swerdlow, S.H., and International Agency for Research on Cancer, Curatori (2008). 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