Acute myeloid leukemia

Evolving treatment patterns and outcomes in older patients (≥60 years) with AML: changing everything to change nothing?

Abstract

There are no studies analyzing how therapeutic changes impact on outcomes of older AML patients. This study analyzes patient´s and disease characteristics, treatment patterns, and outcomes of 3637 AML patients aged ≥60 years reported to the PETHEMA registry. Study periods were 1999–2006 (before hypomethylating agents-HMAs availability) vs 2007–2013, and treatments were intensive chemotherapy (IC), non-intensive, clinical trial (CT), and supportive care only (SC). Median age was 72 (range, 60–99), 57% male, median ECOG 1 (range, 0–4), secondary AML 914 (30%), with adverse-risk genetic in 720 (32%). Treatment differed between study periods (1999–2006 vs 2007–2013): IC 58% vs 32%, non-intensive 1 vs 23%, CT 0 vs 2%, SC 27 vs 28% (p < 0.001). Median OS was 4.7 months (1-year OS 29% and 5-years 7%, without differences between periods), 1.2 for SC, 7.8 for non-intensive, 8.6 for IC, and 10.4 for CT (p < 0.001). OS improved in the 2007–2013 period for IC patients (10.3 vs 7.5 months, p = 0.004), but worsened for SC patients (1.2 vs 1.6 months, p = 0.03). Our real-life study shows that, despite evolving treatment for elderly patients during the last decade, OS has remained unchanged. Epidemiologic registries will critically assess whether novel therapies lead to noteworthy advances in the near future (#NCT02606825).

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Fig. 1: Consolidated Standards of Reporting Trials (CONSORT) diagram for AML patients aged ≥60 years old.
Fig. 2: Therapeutic approach distribution according to different baseline characteristics.
Fig. 3: Overall survival (OS) in elderly AML patients.

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Acknowledgements

The authors would like to thank María D. García, Carlos Pastorini, and Mar Benlloch for data collection and management. This study was supported in part by Janssen Pharmaceutica, and the Cooperative Research Thematic Network (RTICC) (Grant RD12/0036/014 (ISCIII & ERDF).

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DMC and PM conceived the study. DMC and PM analyzed, interpreted the data and wrote the paper; DMC and PM performed the statistical analyses; DMC, JS, CG, MT, PMS, JAPS, RGB, CRM, MLP, CB, JB, ELR, MLA, PH, JMAD, TB, MC, MJS, LA, MBV, GRM, SV, MMPE, AL, VN, MGF, FR, JIRG, LCB, JL, BB, RRV, JML, MAS and PM included data of patients treated in their institutions, reviewed the paper and contributed to the final draft.

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Correspondence to Pau Montesinos.

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Martínez-Cuadrón, D., Serrano, J., Gil, C. et al. Evolving treatment patterns and outcomes in older patients (≥60 years) with AML: changing everything to change nothing?. Leukemia (2020). https://doi.org/10.1038/s41375-020-01058-4

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