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Acute Non-Lymphocytic Leukemias

Attitude towards remission induction for elderly patients with acute myeloid leukemia influences survival

Leukemia volume 20, pages 42–47 (2006)Cite this article

Abstract

Combination chemotherapy may induce remission from acute myeloid leukemia (AML), but validated criteria for treatment of elderly are lacking. The remission intention (RI) rate for elderly patients, as reported to the Swedish Leukemia Registry, was known to be different when comparing the six health care regions, but the consequences of different management are unknown. The Leukemia Registry, containing 1672 AML patients diagnosed between 1997 and 2001, with 98% coverage and a median follow-up of 4 years, was completed with data from the compulsory cancer and population registries. Among 506 treated and untreated patients aged 70–79 years with AML (non-APL), there was a direct correlation between the RI rate in each health region (range 36–76%) and the two-year overall survival, with no censored observations (6–21%) (χ2 for trend=11.3, P<0.001; r2=0.86, P<0.02, nonparametric). A 1-month landmark analysis showed significantly better survival in regions with higher RI rates (P=0.003). Differences could not be explained by demographics, and was found in both de novo and secondary leukemias. The 5-year survival of the overall population aged 70–79 years was similar between the regions. Survival of 70–79-year-old AML patients is better in regions where more elderly patients are judged eligible for remission induction.

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Acknowledgements

The Register is supported by the Swedish National Board of Health and Welfare. GJ is chairman of the acute leukemia registry group and mainly responsible for the analyses and is the author of the manuscript. RB was chairman of the registry from 1996 to 2002. RB, AG, EH-L, MH, KK, AW, and MÅ are MDs and regional clinical representatives of the registry; CA, UB-A, EF, EH, KN, and FW are regional data managers at the regional oncology centers; DS is chairman of the Swedish Society of Hematology; JC is a professor of biostatistics. GJ is a professor at the Lund Strategic Research Center for Stem Cell Biology and Cell Therapy.

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Authors and Affiliations

  1. Department of Hematology, University Hospital and Regional Oncology Centre, Linköping, Sweden

    G Juliusson, K Karlsson, J Carstensen & K Nordenskjöld

  2. Department of Hematology, University Hospital and Regional Oncology Centre, Lund, Sweden

    G Juliusson, R Billström & C Arnesson

  3. Department of Hematology, Karolinska University Hospital and Regional Oncology Centre, Stockholm, Sweden

    A Gruber & E Fredriksson

  4. Department of Hematology, Karolinska University Hospital, Huddinge, Sweden

    E Hellström-Lindberg

  5. Department of Medicine, Academic Hospital and Regional Oncology Centre, Uppsala, Sweden

    M Höglund & U Brunell-Abrahamsson

  6. Department of Medicine, Sahlgrenska University Hospital and Regional Oncology Centre, Gothenburg, Sweden

    D Stockelberg & E Holmberg

  7. Department of Medicine, Norrland University Hospital and Regional Oncology Centre, Umeå, Sweden

    A Wahlin & F Wiklund

  8. Department of Medicine, University Hospital, Örebro, Sweden

    M Åström

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  1. G Juliusson
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  2. R Billström
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  3. A Gruber
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  8. A Wahlin
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  9. M Åström
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  11. U Brunell-Abrahamsson
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for the Swedish Adult Acute Leukemia Registry Group

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Correspondence to G Juliusson.

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Juliusson, G., Billström, R., Gruber, A. et al. Attitude towards remission induction for elderly patients with acute myeloid leukemia influences survival. Leukemia 20, 42–47 (2006). https://doi.org/10.1038/sj.leu.2404004

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