Healthcare resource utilization trends in patients with acute myeloid leukemia ineligible for intensive chemotherapy receiving first‐line systemic treatment or best supportive care: A multicenter international study

Abstract

Objectives This retrospective chart review examined real‐world healthcare resource utilization (HRU) in patients with AML ineligible for intensive therapy who received first‐line systemic therapy or best supportive care (BSC). Methods Data were collected anonymously on patients with AML who initiated first‐line hypomethylating agents (HMA), low‐dose cytarabine (LDAC), other systemic therapy, or BSC. HRU endpoints included hospitalizations, outpatient consultations, transfusions, and supportive care. Results Of 1762 patients included, 46% received HMA, 11% received LDAC, 17% received other systemic therapy, 26% received BSC; median treatment durations were 118, 35, 33, and 57 days, respectively. Most patients were hospitalized, most commonly for treatment administration, transfusion, or infection (HMA 82%, LDAC 93%, other systemic therapy 83%, BSC 83%). A median number of hospitalizations were 2–6 across systemic groups and two for BSC, with median durations of 8–18 days. Transfusion rates and outpatient consultations were highest for HMA (80% and 79%) versus LDAC (57% and 53%), other systemic therapy (57% and 63%), and BSC (71% and 66%). Antivirals/antibiotics and antifungals were used more frequently than growth factors (72–92%, 34–63%, and 7–27%, respectively). Conclusion Patients with AML ineligible for intensive therapy have high HRU; novel therapies are needed to alleviate this burden.

Modification of the antibiotic, colistin, with dextrin causes enhanced cytotoxicity and triggers apoptosis in myeloid leukemia

“…Here, we showed that colistin sulfate was less cytotoxic to leukemia cell lines than a normal kidney cell line. When Speranzini et al 14 treated MV-4-11 cells with colistin, they did not observe any significant alteration in cell growth or H3-Lys 4 /H3-Lys 9 methylation. However, this study used a relatively low concentration of colistin sulfate (1.2 µg/mL, 0.85 µM), given that our study found an IC 50 of this agent in the same cells to be 888 µg/mL (768.5 µM).…”

“…Importantly, infection, due to treatment-related immunosuppression, expression of immunosuppressive molecules or specific defects in the immune response, remains a major cause of death in patients with AML, requiring antibacterial or antiviral therapies to treat infections during first-line treatment. 4 Given the high costs, high risk of failure and protracted development times of new chemotherapy drugs, exploiting the off-target effects of existing antimicrobial agents is an attractive approach to improve survival rates in cancer p[atients.…”

Real-World Treatment Patterns and Clinical Outcomes in Canadian Patients with AML Unfit for First-Line Intensive Chemotherapy

“…The Real-World Treatment Patterns and Clinical Outcomes in Unfit AML Patients Receiving First Line Systemic Treatment or Best Supportive Care (CURRENT) study was a multicenter, multinational non-interventional retrospective chart review designed to understand the clinicopathologic characteristics, treatment patterns, clinical outcomes (including survival), and HRU of AML patients who are unfit to receive intensive chemotherapy in real-world clinical practice. Overall results of the global study have been published elsewhere [ 19 , 20 ]. The focus of this manuscript is the results for the Canadian dataset from the global study.…”

Cost-Effectiveness Analyses in AML: What Have We Learned, How Should This Impact Patient Care, and What Needs to Be Done in the Future?

“…For example, ICU admission rate, supportive care needs (eg, transfusion, antimicrobials), and long-term complications, such as graft-versus-host disease in transplant recipients, have been shown in multiple studies to be associated with a substantial economic burden on the healthcare system. [27][28][29] Reducing the rate of complications can therefore be an important aspect not only from a patient's quality-of-life standpoint but also with regard to health economic considerations.…”