An Evaluation of Treatment Patterns and Outcomes in Elderly Patients Newly Diagnosed With Acute Myeloid Leukemia: A Retrospective Analysis of Electronic Medical Records From US Community Oncology Practices

Ma, Esprit; Bonthapally, Vijayveer; Chawla, Anita; Lefèbvre, Patrick; Swords, Ronan; Lafeuille, M.H.; Fortier, Jonathan; Émond, Bruno; Duh, Mei Sheng; Dezube, Bruce J.

doi:10.1016/j.clml.2016.08.006

Cited by 33 publications

(28 citation statements)

References 32 publications

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“…A lack of standardization of treatment has also been reported in other studies regarding treatment decisions for elderly patients with AML. 19,20 Additionally, these studies made the argument that palliative care is used too frequently among older patients without considering the tolerability of intensive treatments and weighing factors such as age, genetic and cytogenetic profiles, and overall health.…”

Section: Discussionmentioning

confidence: 99%

“…Intensive induction therapies tend to be more commonly used in younger patients, 20 who are in their first relapse may use intensive re-induction. In the present study, the treatment combinations used to define guideline-recommended regimens were broader than those detailed in all the guidelines mentioned above, thus providing a conservative estimate of the percentages of patients who did not receive guideline-recommended treatments.…”

Section: Discussionmentioning

confidence: 99%

“…However, while real-world treatment patterns among patients with AML have been assessed in some claims data studies, these studies mostly focused on elderly patients in the United States and did not differentiate between patients with FLT3 mut AML and FLT3 wild-type AML (FLT3 wt AML). 19,20 The evolving AML treatment landscape is also likely to change how healthcare resources are utilized in clinical practice. Previous studies have shown that the clinical management of AML is very resource intensive, as evidenced by elevated treatment costs largely driven by hospitalizations.…”

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confidence: 99%

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Treatment patterns and healthcare resource utilization in patients withFLT3‐mutated and wild‐type acute myeloid leukemia: A medical chart study

Griffin

Yang

Song

et al. 2019

European J of Haematology

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ObjectivesTo assess real‐world treatment patterns and healthcare resource utilization (HRU) among patients with FLT3–mutated (FLT3 mut) and FLT3–wild‐type (FLT3 wt) acute myeloid leukemia (AML).MethodsData were abstracted from medical charts of patients with AML from 10 countries. Patients were grouped based on their FLT3 mutation status, age (18‐64 or ≥65), and whether they were newly diagnosed (ND) or relapsed/refractory (R/R).ResultsCharts of 1027 AML patients were included (183 FLT3 mut 18‐64 ND; 136 FLT3 mut ≥65 ND; 181 FLT3 mut R/R; 186 FLT3 wt 18‐64 ND; 159 FLT3 wt ≥65 ND; 182 FLT3 wt R/R). Substantial heterogeneity was observed in treatment patterns for AML. Among ND patients 18‐64, the most common initial treatment was standard‐to‐intermediate dose cytarabine‐based therapies (43.2% for FLT3 mut and 55.9% for FLT3 wt); among ND patients ≥65, the most common initial treatment was hypomethylating agent‐based therapies (36.0% and 47.2%). Among R/R patients, the most common initial treatment after R/R was best supportive care only (39.8% and 24.7%). HRU was substantial across cohorts during both event‐free and post‐event periods.ConclusionsTreatment patterns of AML were heterogeneous and FLT3 mut AML was treated more aggressively than FLT3 wt disease. HRU was substantial for all cohorts, particularly after relapse or treatment failure.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Treatment patterns and healthcare resource utilization in patients withFLT3‐mutated and wild‐type acute myeloid leukemia: A medical chart study

Griffin

Yang

Song

et al. 2019

European J of Haematology

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“…When elderly AML patients have favorable cytogenetics, IC can induce complete remission as often as 80%. But despite these high CR rates, OS remains poor …”

Section: Introductionmentioning

confidence: 99%

Outcome of elderly patients after failure to hypomethylating agents given as frontline therapy for acute myeloid leukemia: Single institution experience*

et al. 2017

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Outcomes of acute myeloid leukemia (AML) in elderly patients unfit for intensive chemotherapy is challenging. Hypomethylating agents (HMAs) can be effective in these patients but responses are usually short-lived. The majority of patients will either have stable disease or progress through therapy. We hereby describe the outcome of these patients at our institution after they fail HMAs. The data on 56 AML patients at Mayo Clinic, Rochester were reviewed. Patients were considered for our study if they received HMA as frontline therapy for their AML. Out of 56 patients, 15 (27%) patients received azacitidine (AZA) and 41 (73%) received decitabine. Complete remission was found in 10 (18%), with overall response of 28% and median response duration of 10 months. Thirteen (81%) out of 16 responders relapsed. Therefore 53 patients were included in the primary or secondary failure analysis with a median overall survival (OS) of 2 months after the date of failure. Out of 53 patients, 12 (23%) received subsequent treatments. None of the 12 patients who got first salvage therapy achieved remission. Five out of the 12 patients received second salvage therapy, 2 (40%) of which achieved CR. Median OS for patients who received subsequent salvage therapies was better than those who did not receive any subsequent therapy after failing HMA (9.5 vs. 2 months, P = .0009). Outcome for patients who have primary or secondary failure is very poor. Our study provides important historical data for future novel therapies, which are sorely needed for these patients.

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“…Although past research has suggested that patients up to age 80 years may be considered for intensive therapies 13,14 , lower-intensity treatment regimens are routinely chosen for this cohort of patients with AML, in part due to the poor outcomes observed in older patients treated with standard CURRENT MEDICAL RESEARCH AND OPINION cytarabine-anthracycline induction regimens 5,15 . In practice, available real-world evidence suggests that a sizeable proportion of older patients (aged !60 years) often receive no antileukemic therapy 16 and that treatment with intensive induction strategies is uncommon in community oncology practice 17 . Treatment decisions for older patients are complex and should reflect the overall goals of care, which may include achieving remission, prolonging survival or preserving quality of life 18,19 .…”

Section: Discussionmentioning

confidence: 99%

Treatment patterns in patients with acute myeloid leukemia in the United States: a cross-sectional, real-world survey

Medeiros

Pandya

Hadfield

et al. 2019

Current Medical Research and Opinion

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Objective: The aim of this analysis was to examine treatment patterns in patients with acute myeloid leukemia (AML) in routine clinical practice in the United States, including factors influencing the choice of front-line treatment intensity and the effect of age and treatment line. Methods: We used data from the Adelphi AML Disease Specific Programme, a real-world, cross-sectional survey conducted in 2015. Physicians completed patient record forms providing patients' demographic and clinical characteristics. Results: In total, 61 academic, non-academic, and office-based hematologists and hematology/oncology specialists provided data on 457 patients with AML; 284 had !20% blasts (World Health Organization defined AML) and were included in the analysis. In the front-line setting, 60% of patients received high-intensity therapy, most commonly cytarabine plus anthracycline; the most common lowintensity treatments were hypomethylating agents. Primary drivers for selecting high-intensity versus low-intensity treatment were age, performance status and comorbidities; 67%, 64% and 61% of physicians stated they would prescribe high-intensity treatment to patients aged <65 years, with good performance status or no comorbidities, respectively. In practice, patients aged <60 years were more likely to receive high-intensity induction treatment (high vs. low intensity by age p < .0001). In a selected cohort of relapsed/refractory patients, 69% of patients received high-intensity therapy (78% of patients aged <60 years and 57% of patients aged !60 years). Conclusions: Most patients in this analysis of real-world survey data received well established, frontline induction therapies. Treatment intensity was determined by age, comorbidities and performance status, as recommended by guidelines.

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An Evaluation of Treatment Patterns and Outcomes in Elderly Patients Newly Diagnosed With Acute Myeloid Leukemia: A Retrospective Analysis of Electronic Medical Records From US Community Oncology Practices

Abstract: As expected, OS in patients receiving low-intensity therapy or BSC with HU is poor for elderly patients with AML. Remarkably, intensive induction strategies are rarely used for older patients in community oncology practice.

Cited by 33 publications

References 32 publications

Treatment patterns and healthcare resource utilization in patients withFLT3‐mutated and wild‐type acute myeloid leukemia: A medical chart study

Treatment patterns and healthcare resource utilization in patients withFLT3‐mutated and wild‐type acute myeloid leukemia: A medical chart study

Outcome of elderly patients after failure to hypomethylating agents given as frontline therapy for acute myeloid leukemia: Single institution experience*

Treatment patterns in patients with acute myeloid leukemia in the United States: a cross-sectional, real-world survey

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