Younger Patients, Select Subsets in AML May Have Higher Chances of Long-Term Survival

Ten-year overall survival is low among patients with acute myeloid leukemia , but an analysis demonstrated that survival is shorter for older patients treated with chemotherapy alone, according to published findings.

Ten-year overall survival (OS) is low among patients with acute myeloid leukemia (AML), but an analysis demonstrated that survival is shorter for older patients treated with chemotherapy alone, according to the findings published in Blood.

Studies have shown that younger patients, as well as a subset of older patients, have excellent short-term OS, but translating these findings into the real-world setting has been challenging. Additionally, longer-term OS data are often not available, so the purpose of this study was to determine the age-based probability of 10-year OS in a larger population of patients in a US National Cancer Data Base.

The study included patients with AML who were over the age of 18 and had been diagnosed between 2004 and 2007. Investigators used logistic regression to identify predictors of 10-year OS. Overall, 15,646 patients were included in this analysis, of which 9067 were 60 years or older and 5205 were 18 to 59 years old. Among these patients, 279 in the older group and 1095 in the younger group had been treated with hematopoietic cell transplantation (HCT).

The findings showed 10-year OS was achieved by 2.2% of patients in the older group and 12.7% in the younger group (P <.001). Among patients who had received chemotherapy followed by upfront HCT, the 10-year OS rate was 16.1% for the older group and 24.3% for the younger group (P <.0001).

Investigators evaluated the 10-year OS probabilities across several patient subsets in the younger group. The findings showed that increasing age was associated with lower chances of 10-year OS. The 10-year OS probability was 18% in those who did not receive HCT and 27% in the HCT-treated group among patients aged 18 to 39 years, 13% and 29% for ages 40 to 49, 11% and 21% for ages 50 to 54, and 8% and 17% for ages 55 to 59.

The 10-year OS probabilities among men versus women were 11% vs 15% among those without HCT and 21% vs 27% with HCT. Those with a Charlson-Deyo score of 1 or higher had a lower probability of 10-year OS (8% without HCT and 18% with HCT) than those with a score of 0 (18% and 25%, respectively).

In terms of AML subtypes, the 10-year OS probability was 24% without HCT and 35% with HCT among those with core-binding factor, 8% and 23% with transformed AML/AML MRC, and 12% and 24% for all other subtypes, respectively.

Among patients aged 18 to 59 who were treated with chemotherapy, the 10-year OS was lower among those with older age, male gender, Charlson-Deyo comorbidity score >0, insurance other than private, and subtypes other than core-binding factor AML. Among those treated with HCT, lower 10-year OS was associated with older age, male gender, and insurance other than private.

To improve the long-term OS of patients with AML, innovative treatment approaches are needed. Further studies aimed to identify the cause of death may be insightful.

Reference

Bhatt VR. Age-Based Probability of Ten-Year Overall Survival (OS) of Acute Myeloid Leukemia (AML): a National Cancer Database (NCDB) Analysis.Blood. 2020;136 (suppl 2):24-25. doi: 10.1182/blood-2020-134434