Outcome of older patients with acute myeloid leukemia

Abstract

BACKGROUND Acute myeloid leukemia (AML) is the common form of acute leukemia in adults, accounting for over 80% of all acute leukemia in those over the age of 18 years. Overall 5-year survival remains poor in older AML patients; it is less than 5% in patient over 65 years. We examined whether survival has improved for subsets of geriatric AML patients over three successive decades. METHODS Surveillance, Epidemiology, and End Results (SEER) data were used to determine trends in relative survival by age among 19,000 AML patients over three successive decades (1977–1986, 1987–1996, and 1997–2006). Relative survival rates (RR) with 95% confidence intervals (CIs) were calculated as measures of survival. RESULTS Overall, relative survival rates increased for each successive decade (1977–1986, 1987–1996, 1997–2006) in patients aged 65–74 years, with improvement in 12-month survival from 20% to 25% to 30%. Findings were similar for 24-month, 36-month, 48-month and 60-month survival. However, survival rates did not improve in patients 75 years and older. The oldest-old (85 years and older) had the lowest survival rates, with no apparent improvement. CONCLUSION Analysis of a large data set demonstrated that, while overall survival remains unsatisfactory among older patients, it has in fact improves in the younger old (65–74 years). Survival of older old AML patients has not been favorably impacted by available AML therapies or supportive care, and intervention in this age group is best undertaken on a clinical trial.

Expression levels of the runt-related transcription factor�1 and�3 genes in the development of acute myeloid leukemia

“…AML accounts for ~80% of all acute leukemia cases in adults, and the incidence of this disease has been revealed to increase with age (2,3). At present, AML is curable in 35-40% of patients <60 years old; however, among patients >60 years of age, cases of full recovery are less common (5-15%) (1,4).…”

“…At present, AML is curable in 35-40% of patients <60 years old; however, among patients >60 years of age, cases of full recovery are less common (5-15%) (1,4). Due to the fact that survival rates remain relatively low (overall 5-year survival is <5% in older patients), novel therapeutics and treatment strategies are required (3).…”

Chemotherapy-induced hypomethylation of N-myc downstream-regulated gene 4 in the bone marrow of patients with acute myeloid leukemia

“…The clinical characteristics of elderly patients with AML differ from those of younger patients, with poorer survival and treatment outcomes (34). Surveillance, epidemiology and end results data demonstrated that the overall 5-year survival was <5% in patients aged >65 years of age (35); however, those patients who received high-dose chemotherapy exhibited improved outcomes (34). In the current study, more changeable hypomethylation was observed in elderly patients (particularly patients with M2 subtype AML) than in younger patients, which may facilitate the elucidation of age-associated variations in clinical treatment methods.…”

Oral Azacitidine (CC-486) for the Treatment of Myelodysplastic Syndromes and Acute Myeloid Leukemia

“…Similar to MDS, AML incidence increases with advancing age, with incidence rates in the U.S. and Europe of 10 per 100,000 persons or higher for patients aged $65 years [14,15]. AML has a poor prognosis, particularly in older patients and those with adverse disease characteristics (e.g., secondary AML, complex cytogenetic abnormalities, or FLT3 mutation) [26][27][28][29][30]. Three-quarters of patients with AML die within 5 years of diagnosis, and survival decreases with increasing age [26].…”

“…AML has a poor prognosis, particularly in older patients and those with adverse disease characteristics (e.g., secondary AML, complex cytogenetic abnormalities, or FLT3 mutation) [26][27][28][29][30]. Three-quarters of patients with AML die within 5 years of diagnosis, and survival decreases with increasing age [26]. Disease characteristics and performance status are closely considered when evaluating patient eligibility for treatment with intensive therapies (e.g., induction followed by consolidation chemotherapy or stem cell transplant [SCT]) versus low-intensity options such as injectable azacitidine or decitabine [27][28][29][31][32][33].…”