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:	Mario Tiribelli, Angela Michelutti, Margherita Cavallin, Sara Di Giusto, Erica Simeone, Renato Fanin, Daniela Damiani
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	BCL-2 acute myeloid leukemia elderly prognosis survival Medicine R
Acceso en línea:	https://doaj.org/article/802def0c29cb45748f2e5f9266f5854a
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spelling	oai:doaj.org-article:802def0c29cb45748f2e5f9266f5854a2021-11-11T17:43:05ZBCL-2 Expression in AML Patients over 65 Years: Impact on Outcomes across Different Therapeutic Strategies10.3390/jcm102150962077-0383https://doaj.org/article/802def0c29cb45748f2e5f9266f5854a2021-10-01T00:00:00Zhttps://www.mdpi.com/2077-0383/10/21/5096https://doaj.org/toc/2077-0383BCL-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 (<i>n</i> = 51) or hypomethylating agents (HMAs) (<i>n</i> = 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; <i>p</i> = 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.Mario TiribelliAngela MicheluttiMargherita CavallinSara Di GiustoErica SimeoneRenato FaninDaniela DamianiMDPI AGarticleBCL-2acute myeloid leukemiaelderlyprognosissurvivalMedicineRENJournal of Clinical Medicine, Vol 10, Iss 5096, p 5096 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	BCL-2 acute myeloid leukemia elderly prognosis survival Medicine R
spellingShingle	BCL-2 acute myeloid leukemia elderly prognosis survival Medicine R Mario Tiribelli Angela Michelutti Margherita Cavallin Sara Di Giusto Erica Simeone Renato Fanin Daniela Damiani BCL-2 Expression in AML Patients over 65 Years: Impact on Outcomes across Different Therapeutic Strategies
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 (<i>n</i> = 51) or hypomethylating agents (HMAs) (<i>n</i> = 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; <i>p</i> = 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.
format	article
author	Mario Tiribelli Angela Michelutti Margherita Cavallin Sara Di Giusto Erica Simeone Renato Fanin Daniela Damiani
author_facet	Mario Tiribelli Angela Michelutti Margherita Cavallin Sara Di Giusto Erica Simeone Renato Fanin Daniela Damiani
author_sort	Mario Tiribelli
title	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_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_sort	bcl-2 expression in aml patients over 65 years: impact on outcomes across different therapeutic strategies
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/802def0c29cb45748f2e5f9266f5854a
work_keys_str_mv	AT mariotiribelli bcl2expressioninamlpatientsover65yearsimpactonoutcomesacrossdifferenttherapeuticstrategies AT angelamichelutti bcl2expressioninamlpatientsover65yearsimpactonoutcomesacrossdifferenttherapeuticstrategies AT margheritacavallin bcl2expressioninamlpatientsover65yearsimpactonoutcomesacrossdifferenttherapeuticstrategies AT saradigiusto bcl2expressioninamlpatientsover65yearsimpactonoutcomesacrossdifferenttherapeuticstrategies AT ericasimeone bcl2expressioninamlpatientsover65yearsimpactonoutcomesacrossdifferenttherapeuticstrategies AT renatofanin bcl2expressioninamlpatientsover65yearsimpactonoutcomesacrossdifferenttherapeuticstrategies AT danieladamiani bcl2expressioninamlpatientsover65yearsimpactonoutcomesacrossdifferenttherapeuticstrategies
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BCL-2 Expression in AML Patients over 65 Years: Impact on Outcomes across Different Therapeutic Strategies

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