Survival of elderly patients with acute myeloid leukemia

Acta Oncologica, 2014

Background. Survival in acute myeloid leukemia (AML) has improved in younger patients over the last decade. This study was conducted to evaluate the relative survival rates in older AML patients over two decades in the US. Material and methods. We analyzed Surveillance, Epidemiology, and End Results (SEER) registry database to evaluate relative survival rate in older (Ն 75 years) AML population diagnosed during 1992-2009. We selected AML patients from 13 registries of SEER 18 database to compare RS during 1992-2000 and 2001-2009. Results. The relative survival rates improved signifi cantly during 2001-2009 compared to 1992-2000 for all age groups and sex. For young elderly patients (75-84 years) RS increased from 13.1 Ϯ 0.8% to 17.4 Ϯ 0.9% at one year Z-value ϭ 3.98, p Ͻ 0.0001 and from 2.0 Ϯ 0.4 to 2.6 Ϯ 0.5%, Z-value ϭ 3.61, p Ͻ 0.0005 at fi ve years. Similarly, for very elderly (Ն 85 years) patients RS increased from 5.3 Ϯ 1.0% to 8.0 Ϯ 1.0%, Z-value ϭ 3.03, p Ͻ 0.005 at one year, but no improvement seen at fi ve years. Conclusion. The relative survival in elderly AML has increased signifi cantly during 2001-2009 compared to 1992-2000.

Blood, 2010

We present an analysis of prognostic factors derived from a trial in patients with acute myeloid leukemia older than 60 years. The AML96 trial included 909 patients with a median age of 67 years (range, 61-87 years). Treatment included cytarabine-based induction therapy followed by 1 consolidation. The median follow-up time for all patients is 68 months (5.7 years). A total of 454 of all 909 patients reached a complete remission (50%). Five-year overall survival (OS) and disease-free survival were 9.7% and 14%, respectively. Multivariate analyses revealed that karyotype, age, NPM1 mutation status, white blood cell count, lactate dehydrogenase, and CD34 expression were of independent prognostic significance for OS. On the basis of the multivariate Cox model, an additive risk score was developed that allowed the subdivision of the largest group of patients with an intermediate-risk karyotype into 2 groups. We are, therefore, able to distinguish 4 prognostic groups: favorable risk, good intermediate risk, adverse intermediate risk, and high risk. The corresponding 3-year OS rates were 39.5%, 30%, 10.6%, and 3.3%, respectively. The risk model allows further stratification of patients with intermediate-risk karyotype into 2 prognostic groups with implications for the therapeutic strategy. This study was registered at www.clinicaltrials.gov as #NCT00180115. (Blood. 2010;116(6):971-978) Figure 2. OS probability of the 4 risk groups identified by the additive risk model. Whereas the favorable-risk group (3-year OS, 39.5%) and the high-risk group (3-year OS, 3.3%) are defined solely by cytogenetic aberrations, the intermediate-risk group can be subdivided into good intermediate (Յ 3 adverse risk points; 3-year OS, 30.0%) and adverse intermediate (Ͼ 3 adverse risk points; 3-year OS, 10.6%

Medical Oncology, 2012

Using various risk factor scores, we aimed to identify a subset of elderly patients with acute myeloid leukaemia (AML) for whom it was possible to assess the prognosis. We also aimed to develop a novel prognostic score system. This single centre study involved 102 patients of C60 years of age with non-promyelocytic AML. The adverse cytogenetic risk group appeared as the most significant independent prognostic factor for overall survival (OS). Our prognostic scoring system was developed after analysing prognostic risk factors and was applied for patients with favourable and intermediate (I and II) cytogenetic risk groups: age \65 years of age, normal lactate dehydrogenase (LDH) and a comorbidity score obtained applying the haematopoietic cell transplantationspecific comorbidity index (HCT-CI) \ 3 = 0 points, in which age C65 years = 1 point and an elevated LDH score and HCT-CI C3 = 2 points. According to this prognostic model, patients without adverse cytogenetics were classified into three risk groups: favourable = 0-2 points, intermediate = 3-4 points and poor = [ 4 points. The OS between these groups was highly significant (p \ 0.001). The prognostic model developed in this study may refine the prognosis procedure of elderly AML patients without an adverse karyotype regarding OS, thereby guiding the treatment approach.

Leukemia Research, 2001

A retrospective analysis was performed on 263 consecutive patients aged over 60 with de novo acute myeloid leukemia (AML) diagnosed in a single institution between 1979 and 1998. Eighty-nine patients (33%) received only palliative treatment, while 174 patients (67%) were treated with different intensive chemotherapy regimens. The 5-and 10-year overall survival (OS) for the whole series was 7.7 91.2 and 4.3 9 1.6%, respectively. For patients receiving chemotherapy, OS was 10.5 9 2.5 and 7 9 2.6%, while for those patients receiving supportive treatment it was 1.1 9 1.1 and 0%, respectively (P = 0.002). Within the group of patients receiving chemotherapy, the complete remission (CR) rate was 46%; treatment failure rate was 54% (36% due to treatment-related mortality and 18% due to resistant disease). Variables influencing CR rate were FAB subtype, CD7 positivity, chemotherapy regimen, creatinine level, hepatomegaly, and period of diagnosis. Median disease-free survival (DFS) duration was 8.4 months with a probability of being disease-free at 10 years of 10 9 5%. There were no significant differences in DFS according to age. According to the period of diagnosis (1979-1986 vs. 1987-1998), improvements in the CR rate (27 vs. 56%, P = 0.0002), and OS (10.9 vs. 15.7 months, P =0.0007) were observed. This large single-center study of unselected de novo AML elderly patients substantiates the progressive improvement achieved in the management of elderly patients with AML, probably due to an improvement in supportive care and the administration of conventional induction chemotherapy.

British Journal of Haematology, 2001

Low-dose cytarabine and aclarubicin in combination with granulocyte colony-stimulating factor (CAG regimen) for previously treated patients with relapsed or primary resistant acute myelogenous leukemia (AML) and previously untreated elderly patients with AML, secondary AML and refractory anemia with excess blasts in transformation.

2008

Background-Treating the octogenarian and nonagenarian acute myeloid leukemia (AML) patients with intensive chemotherapy is controversial. Several models to predict outcome were proposed including the use of a co-morbidity index. However, it is unclear whether Charlson Comorbidity Index (CCI) or Hematopoietic Cell Transplant Co-morbidity Index (HCTCI) is more sensitive.

Cancer, 1996

BACKGROUND. This study aimed to define pre-treatment parameters with prognostic significance in elderly patients with de novo acute myeloid leukemia (AML) who were treated with aggressive regimens.

Cancer, 2006

BACKGROUND. Elderly patients (age Ն 65 years) with acute myeloid leukemia (AML) generally have a poor prognosis. AML-type therapy results are often derived from studies in younger patients and may not apply to elderly AML. Many investigators and oncologists advocate, at times, only supportive care or frontline single agents, Phase I-II studies, low-intensity regimens, or 'targeted' therapies. However, baseline expectations for outcomes of elderly AML with 'standard' AML-type therapy are not well defined. The aim was to develop prognostic models for complete response (CR), induction (8-week) mortality, and survival rates in elderly AML, which would be used to advise oncologists and patients of expectations with standard AML type therapy, and to establish baseline therapy results against which novel strategies would be evaluated.

Cancer, 2009

BackgroundTreating the octogenarian and nonagenarian acute myeloid leukemia (AML) patients with intensive chemotherapy is controversial. Several models to predict outcome were proposed including the use of a co-morbidity index. However, it is unclear whether Charlson Co-morbidity Index (CCI) or Hematopoietic Cell Transplant Co-morbidity Index (HCTCI) is more sensitive.MethodsWe analyzed our experience with 92 AML patients ≥80 years old. We recorded the patients’ pretreatment characteristics and their treatment outcome.ResultsAll patients were offered intensive treatment; 59 (64%) were treated intensively with a variety of regimens while 33 (36%) elected to receive supportive care. CCI and HCTCI had similar predictive ability for outcome in both groups. Multivariate analyses of the prognostic factors identified near-normal albumin (48% of the patients; 1-year survival rate >27%) as a favorable factor for the whole cohort, age <83 (47% of the patients; 1-year survival rate >25%) and non-monocytic morphology (75% of the patients; 1-year survival rate >26%) for the intensively-treated cohort and bone marrow blasts <46% (50% of the patients; 1-year survival rate >19%) for those who received supportive care.ConclusionsThis retrospective analysis was developed to assist in treatment decisions for octogenarian and nonagenarian AML patients. These findings will need validation in a prospective study.

Hematological …, 1990

One hundred and fifteen previously untreated adults aged over 60 years were referred to St Bartholomew's Hospital between 1978 and for management of acute myeloid leukemia (AML). Twenty-seven patients received symptomatic or palliative treatment only because combination chemotherapy was considered inappropriate.