Elderly AML: A Five-Year Retrospective Review on Prognostic Features

Abstract

Background: Acute Myeloid Leukemia (AML) is a disease of the elderly with a median age of diagnosis of 70 years. Prognosis in this age group is poor, with median overall survival of those undergoing treatment ranging from seven to twelve months. Treatment is difficult for a variety of reasons, including - higher incidence of co-morbid conditions (including frailty and decline in functional status), decreased ability to tolerate infections, socioeconomic considerations, and more aggressive disease phenotype. We present a single-institution retrospective review of acute myeloid leukemia outcomes with respect to these and other variables. Methods: A retrospective chart review was performed on all patients with a new diagnosis of AML from November 2013 through October 2017. Descriptive statistics were performed using excel, inferential statistics including Kaplan-Meier with comparison of survival curves by Logrank test and Cox-proportional hazard regression analysis, and correlation coefficients were performed using MEDCALC statistical software package. Results: Eighty-four AML patients in total were diagnosed with acute myeloid leukemia within the specified time frame, of these, 45 patients were age 65 or older (elderly) and were included in further analysis. Median age of elderly AML patients in this study was 70 years. Six of these patients were diagnosed with secondary AML (having arisen from MDS (N = 4), or other hematologic malignancy (N=2), and two had therapy-related AML. Eight patients had favorable risk disease, 13 intermediate risk, and 24 adverse risk according to ELN 2017 criteria. The median survival of all elderly patients was 322 days. Median survival of elderly AML according to ELN 2017 risk category criteria (Favorable, Intermediate, or Poor) was not reached (mean 880 days), 390 days, and 117 days, respectively (p = 0.0368 by cox hazard regression). Survival was not affected by type of treatment (induction vs hypomethylating agent (HMA); median 579 and 166 days (p = 0.1378) and mean 1552 and 364 days, respectively. This is likely due to small sample size, although survival does appear to favor intensive induction. Survival was not affected by number of medical co-morbidities (p = 0.66), presence of infectious complications (p=0.152), or unplanned hospitalization (p = 0.144). Overall use of clinical trials (N=3) and transplant (N=2) were low, precluding meaningful statistical analysis. However, both patients undergoing transplant exceeded the median OS (579 and 4745 days). Median OS of patients identified as White/Caucasian was greater than those identified as Hispanic/Latino (166 days vs 66 days, respectively), this did not reach statistical significance. Conclusion: Given the limitations of a retrospective review and relatively small sample size, our data shows that the 2017 ELN risk category is the strongest predictor of overall survival. Statistically, those undergoing intensive induction did not have a longer overall survival than those treated with HMAs, highlighting the need for careful selection of induction therapy candidates, and the need for clinical trials investigating other less intense treatment options for patients in this category. Interestingly, number of medical co-morbidities did not influence overall survival, nor did unplanned hospitalizations, presence/absence of significant infections during therapy, or race/ethnicity. Our data suggest an under-utilization of clinical trials and allogeneic hematopoietic stem cell transplant, both of which may serve to improve prognosis. Disclosures No relevant conflicts of interest to declare.

Decoding Sepsis-Induced Disseminated Intravascular Coagulation: A Comprehensive Review of Existing and Emerging Therapies

“…A notable phase 4 study conducted in patients with septic DIC provided results worth considering. This study found no improvement in 28-day mortality associated with the use of antithrombin in this population [128,131,137,[140][141][142][143][145][146][147]. Interestingly, there is growing interest in the concept of combination therapy.…”

“…Therefore, the question of whether anticoagulant therapy is generally beneficial for sepsis patients remains a controversial topic in the scientific community. Anticoagulation plays a central role in the body's innate defense mechanisms against infections [139,140]. However, widespread, and indiscriminate use is discouraged due to the increased risk of bleeding.…”

Metal–Organic Framework-Based Fluorescent Sensors for the Detection of Pharmaceutically Active Compounds

“…If they form in the wrong places, they can block arteries and prevent blood from reaching organs such as the heart, brain, or lungs, resulting in strokes, heart attacks, pulmonary embolism, or deep vein thrombosis. However, the clotting of blood is necessary for the halting of bleeding . Anticoagulant drugs are generally recommended when one of the aforementioned situations is developed in our body.…”

“…Anticoagulants function by stopping the process that results in blood clots. However, the excess use of anticoagulants can result in chest pain, back pain, heavy periods in the case of women and secretion of blood with urine, vomit, and stool. , As a result, measuring the concentration of these medications in various body fluids is required. Several anticoagulant drug sensors have been reported in recent times, and few of them are using fluorescent MOFs.…”

Assessment of prescribing pattern and adverse drug reaction in patients receiving anticoagulant therapy: A prospective observational study

“…[3][4][5] These drugs are either used orally (mostly for long-term therapy) or Parenterally (for the prevention and initiation of treatment of thrombosis as well as other surgical procedures) and are among the most frequently implicated medications that cause ADRs in hospitalized patients, mostly elderly patients are at high risk to suffer from anticoagulant-associated ADRs such as ecchymosis, epistaxis, hematuria, gastro intestinal (GI) bleeding, thrombocytopenia, osteoporosis on long term use and hypersensitivity reactions. [6][7][8][9] The present study was aim to evaluate and understand the drug use pattern of oral and Injectable anticoagulants. This prospective study will be helpful to improve current prescription patterns and give insights to minimize the drug therapy problems associated with anticoagulant therapy.…”