1. ¹Department of Hematology, University Hospital and Regional Oncology Centre, Linköping, Sweden
2. ²Department of Hematology, University Hospital and Regional Oncology Centre, Lund, Sweden
3. ³Department of Hematology, Karolinska University Hospital and Regional Oncology Centre, Stockholm, Sweden
4. ⁴Department of Hematology, Karolinska University Hospital, Huddinge, Sweden
5. ⁵Department of Medicine, Academic Hospital and Regional Oncology Centre, Uppsala, Sweden
6. ⁶Department of Medicine, Sahlgrenska University Hospital and Regional Oncology Centre, Gothenburg, Sweden
7. ⁷Department of Medicine, Norrland University Hospital and Regional Oncology Centre, Umeå, Sweden
8. ⁸Department of Medicine, University Hospital, Örebro, Sweden

Correspondence: Professor G Juliusson, Stem Cell Center BMC B10, Lund University, SE 22185 Lund, Sweden. E-mail: Gunnar.Juliusson@med.lu.se

Received 6 May 2005; Revised 8 September 2005; Accepted 15 September 2005; Published online 21 November 2005.

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%) (² 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.