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

Abstract

Acute myeloid leukemia (AML) is a hematological malignancy that predominantly affects the elderly. Prognosis declines with age. For those who cannot tolerate intensive chemotherapy, historically established treatment options have been hypomethylating agents (HMAs), low dose cytarabine (LDAC), and best supportive care (BSC). As the standard of care evolves for those unfit for intensive chemotherapy, there is a need to understand established treatment pathways, clinical outcomes and healthcare resource utilization in Canada. The CURRENT study was a retrospective chart review of AML patients not eligible for intensive chemotherapy who initiated first-line treatment between 1 January 2015 and 31 December 2018. Data were collected from 170 Canadian patients treated at six hematology centers, of whom 118 received systemic therapy and 52 received BSC as first-line treatment. Median overall survival was 8.58 months and varied from 2.96 months for BSC to 13.31 months for HMAs. Over 80% of patients had at least one outpatient visit, and 67% of patients receiving systemic therapy and 71% of those receiving BSC had at least one admission to hospital, during their first line of therapy. A total of 96 (81.4%) patients receiving first line systemic therapy and 39 (75.0%) of those receiving first line BSC had at least one red blood cell or platelet transfusion. These findings highlight the unmet need for novel therapies for patients ineligible for intensive chemotherapy.

Hogyan változott az akut myeloid leukaemiás betegek túlélése a terápiás lehetőségek bővülésével az elmúlt 10 évben klinikánkon?

“…A transzplantált betegek eredményei a legjobbak, de az azacitidin ± venetoklax csoport eredményei gyakorlatilag megegyeznek a nagy dózisú kemoterápiával kezeltekével n = abszolút betegszám; NR = nem elérhető toleráló AML-betegek túlélése, akik a korral növekvő AML-incidencia miatt a kezeltek nagyobb részét alkotják. Az azacitidinterápiás alternatívával az aktív kezelést kapó betegek aránya a két időszak között 57,1%-ról 75,3%-ra nőtt, és jelentős számú beteg került át az azacitidin ± venetoklax csoportba, élvezve az ott elért 8 hónappal hosszabb túlélést, ami nagyságrendileg megegyező a nemzetközi irodalmi adatokkal[4,13,[15][16][17].…”