Survival for older patients with acute myeloid leukemia: a population-based study

Abstract

The online version of this article has a Supplementary Appendix. BackgroundAcute myeloid leukemia is the second most common leukemia among United States adults with a median age of 69 years. We investigated recent clinical practices related to treatments and disease outcomes in older patients with acute myeloid leukemia in the United States. Design and MethodsIn this retrospective cohort study, we used Surveillance, Epidemiology, and End Results program data from 2000 through 2007 linked to Medicare enrollment and utilization data in the United States. ResultsAmong 5,480 patients with acute myeloid leukemia (median age 78 years, range 65-93), 38.6% received leukemia therapy within three months of diagnosis (treated group). Practice changed with 16.3% of treated patients receiving hypomethylating agents after 2004 when those agents became available. Median survival was two months in the untreated group versus six months in the treated group (P<0.01) with the biggest improvements seen in those aged 65-69 years (10 months vs. 4 months; P<0.01) and 70-74 years (8 months vs. 3 months; P<0.01). In 46 patients receiving allogeneic hematopoietic cell transplantation (0.8%), the median survival from diagnosis was 22 months. ConclusionsTherapy for leukemia improves overall survival in older acute myeloid leukemia patients. Based on their comorbidities, most patients up to 80 years of age should be considered for treatment. New therapies including hypomethylating agents and allogeneic hematopoietic cell transplantation are promising and must be compared with other chemotherapy regimens.Key words: acute myeloid leukemia, older patients, treatment, disease outcome, survival.Citation: Oran B, and Weisdorf DJ. Survival for older patients with acute myeloid leukemia: a population-based study. Haematologica 2012;97(12):1916-1924. doi:10.3324/haematol.2012 This is an open-access paper.Survival for older patients with acute myeloid leukemia: a population-based study ABSTRACT© F e r r a t a S t o r t i F o u n d a t i o n

Comparison of epigenetic versus standard induction chemotherapy for newly diagnosed acute myeloid leukemia patients ≥60 years old

“…Despite this, many older individuals continue to be offered only low intensity or best supportive care due to concerns about treatment-related mortality and morbidity with intensive regimens. In recent years, the HMAs, decitabine or azacitidine, have emerged as an alternative induction strategy for older AML patients [41]. Prior studies have demonstrated that HMA therapy results in equivalent or potentially superior outcomes over low-dose cytarabine or best supportive care in older AML patients deemed unsuitable for intensive chemotherapy [34,42].…”

“…In contrast, older individuals with poor-risk karyotype, wild-type NPM-1 mutation, secondary AML, and lower initial WBC may preferentially benefit from Epi therapy. Although not approved in the United States, the expanded off-label use of decitabine as an alternative induction approach for older AML patients has the potential to markedly increase the numbers (and outcomes) of individuals receiving definitive as opposed to supportive care only for this disease [41,42]. Epidemiological data from 2001 to 2009 have recently demonstrated a significant improvement both in percentage of older AML patients receiving treatment and the OS of patients as compared with 1992-2000 [41,53].…”

“…Although not approved in the United States, the expanded off-label use of decitabine as an alternative induction approach for older AML patients has the potential to markedly increase the numbers (and outcomes) of individuals receiving definitive as opposed to supportive care only for this disease [41,42]. Epidemiological data from 2001 to 2009 have recently demonstrated a significant improvement both in percentage of older AML patients receiving treatment and the OS of patients as compared with 1992-2000 [41,53]. Although they may reflect better supportive care measures (i.e., antiemetics and azoles), these figures coincide with the increased availability and usage of HMA for AML therapy since 2005 [41].…”

“…Epidemiological data from 2001 to 2009 have recently demonstrated a significant improvement both in percentage of older AML patients receiving treatment and the OS of patients as compared with 1992-2000 [41,53]. Although they may reflect better supportive care measures (i.e., antiemetics and azoles), these figures coincide with the increased availability and usage of HMA for AML therapy since 2005 [41]. The finding that decitabine induction may be more costeffective than IC in some patients further supports its increased use [54].…”

To transplant or not: a dilemma for treatment of elderly AML patients in the twenty-first century

“…Our recent analysis of US SEER data from 2000 to 2007 revealed that only 38.6% of 5480 elderly AML patients (median age 78 years, range 65-93) received active leukemia therapy within 3 months of diagnosis. 3 This suggests that we need to challenge the status quo in AML treatment. In fact, our SEER study ( Figure 2) and Swedish registry data demonstrated that patients who received leukemia treatment had better survival compared to those who did not.…”