Treatment patterns in patients with acute myeloid leukemia in the United States: a cross-sectional, real-world survey

Abstract

Objective: The aim of this analysis was to examine treatment patterns in patients with acute myeloid leukemia (AML) in routine clinical practice in the United States, including factors influencing the choice of front-line treatment intensity and the effect of age and treatment line. Methods: We used data from the Adelphi AML Disease Specific Programme, a real-world, cross-sectional survey conducted in 2015. Physicians completed patient record forms providing patients' demographic and clinical characteristics. Results: In total, 61 academic, non-academic, and office-based hematologists and hematology/oncology specialists provided data on 457 patients with AML; 284 had !20% blasts (World Health Organization defined AML) and were included in the analysis. In the front-line setting, 60% of patients received high-intensity therapy, most commonly cytarabine plus anthracycline; the most common lowintensity treatments were hypomethylating agents. Primary drivers for selecting high-intensity versus low-intensity treatment were age, performance status and comorbidities; 67%, 64% and 61% of physicians stated they would prescribe high-intensity treatment to patients aged <65 years, with good performance status or no comorbidities, respectively. In practice, patients aged <60 years were more likely to receive high-intensity induction treatment (high vs. low intensity by age p < .0001). In a selected cohort of relapsed/refractory patients, 69% of patients received high-intensity therapy (78% of patients aged <60 years and 57% of patients aged !60 years). Conclusions: Most patients in this analysis of real-world survey data received well established, frontline induction therapies. Treatment intensity was determined by age, comorbidities and performance status, as recommended by guidelines.

Characteristics and Outcomes of Adult Patients in the PETHEMA Registry with Relapsed or Refractory FLT3-ITD Mutation-Positive Acute Myeloid Leukemia

“…To our knowledge, this is the largest real-world study focusing specifically on outcomes in R/R patients with FLT3 -ITD mutation-positive AML. The French DATAML registry study by the Toulouse–Bordeaux group included 160 patients with FLT3 -ITD mutation-positive R/R AML [ 26 ], while other studies were performed in smaller patient populations [ 27 , 28 ]. In the French study, 294 FLT3 -ITD-mutated patients who received FLT3 inhibitors as an intensive first-line treatment regimen were followed-up, resulting in 160 R/R episodes (14 of them treated with second generation FLT3 inhibitors and not evaluated for efficacy).…”

“…However, no outcomes regarding rates of R/R disease, salvage therapies received or outcomes after salvage therapy were reported in the previous study [ 27 ]. Another real-world study of 284 US-based patients with AML evaluated patient characteristics, treatment patterns, as well as outcomes after diagnosis of R/R disease [ 28 ]. However, only 42 of the 284 patients in this study had FLT3 mutations, and no outcomes specific to those patients were given [ 28 ].…”

Glasdegib plus low-dose cytarabine for acute myeloid leukemia: Practical considerations from advanced practitioners and pharmacists

“…However, use has generally declined with the availability of HMAs, with a recent US clinical practice survey finding LDAC accounted for 31% of first-line low-intensity regimens, while HMAs accounted for 45%. 41 At many institutions, LDAC may be reserved for patients who have cycled through other options, such as an elderly patient with refractory AML previously treated with azacitidine, with no targetable mutations and multiple comorbidities, but who desires continued treatment. The general preference for HMAs is not the only reason LDAC holds this place among treatment options: in addition, cytarabine shortages have occurred intermittently over the past 10 years.…”

“…However, use has generally declined with the availability of HMAs, with a recent US clinical practice survey finding LDAC accounted for 31% of first-line low-intensity regimens, while HMAs accounted for 45%. 41…”

An exemplar population-based study to predict up-take of non-intensive therapies in acute myeloid leukaemia

“…Identifying factors that influence treatment decisions in unselected patients would be useful to predict up-take of non-IC. A previous study on Medicare beneficiaries has identified variables influencing intensive treatment in older AML patients, but not the reasons for favouring SC over non-IC [2]. As the use of non-IC in patients increases [3], predicting the size of the target population for non-IC, identifying barriers to therapy and the determinants of survival in 'real-world' patients will help budgetary planning and patient outcomes.…”