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Acute myeloid leukemia

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

Leukemia volume 35, pages 1571–1585 (2021)Cite this article

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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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Authors and Affiliations

  1. Hospital Universitari i Politècnic La Fe, Valencia, Spain

    David Martínez-Cuadrón, Blanca Boluda, Rebeca Rodríguez-Veiga, Miguel A. Sanz & Pau Montesinos

  2. CIBERONC, Instituto Carlos III, Madrid, Spain

    David Martínez-Cuadrón, Joaquín Martínez-López, Miguel A. Sanz & Pau Montesinos

  3. Hospital Universitario Reina Sofía-IMIBIC, Córdoba, Spain

    Josefina Serrano

  4. Hospital General Universitario de Alicante, Alicante, Spain

    Cristina Gil

  5. Hospital Clínico Universitario, INCLIVA Biomedical Research Institute, Valencia, Spain

    Mar Tormo

  6. Hospital Universitario 12 de Octubre, Complutense University, i + 12, CNIO, Madrid, Spain

    Pilar Martínez-Sánchez & Joaquín Martínez-López

  7. Hospital Universitario Virgen del Rocío, Sevilla, Spain

    José A. Pérez-Simón

  8. Hospital General Universitari de Castelló, Castellón, Spain

    Raimundo García-Boyero

  9. Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas, Spain

    Carlos Rodríguez-Medina

  10. Hospital General Universitario de Valencia, Valencia, Spain

    María López-Pavía

  11. Hospital Clínico San Carlos, Madrid, Spain

    Celina Benavente

  12. Hospital San Pedro Alcántara, Cáceres, Spain

    Juan Bergua

  13. Hospital Lucus Augusti, Lugo, Spain

    Esperanza Lavilla-Rubira

  14. Hospital General Universitario Morales Meseguer, Murcia, Spain

    María L. Amigo

  15. Hospital Univeristario Ramón y Cajal, Madrid, Spain

    Pilar Herrera

  16. Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain

    Juan M. Alonso-Domínguez

  17. Hospital Universitario Central de Asturias, Asturias, Spain

    Teresa Bernal

  18. Hospital Universitario Marqués de Valdecilla, Santander, Spain

    Mercedes Colorado

  19. Hospital Universitario Doctor Peset, Valencia, Spain

    María J. Sayas

  20. Hospital General Universitario de Albacete, Albacete, Spain

    Lorenzo Algarra

  21. Hospital Clínico Universitario de Salamanca, Salamanca, Spain

    María B. Vidriales

  22. Hospital General Universitario Gregorio Marañón, Madrid, Spain

    Gabriela Rodríguez-Macías

  23. ICO-Hospital Germans Trias i Pujol, José Carreras Leukemia Research Institute, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain

    Susana Vives

  24. Hospital Clínico Universitario de Santiago-CHUS, Santiago de Compostela, Spain

    Manuel M. Pérez-Encinas

  25. Hospital Arnau de Vilanova, Valencia, Spain

    Aurelio López

  26. Complejo Hospitalario Universitario A Coruña, A Coruña, Spain

    Víctor Noriega

  27. Hospital Universitario Virgen de la Victoria, Málaga, Spain

    María García-Fortes

  28. Hospital Universitario de León, León, Spain

    Fernando Ramos

  29. Hospital Universitario de Basurto, Bizkaia, Spain

    Juan I. Rodríguez-Gutiérrez

  30. Hospital Universitario Miguel Servet, Zaragoza, Spain

    Lisette Costilla-Barriga

  31. Hospital Universitario de Burgos, Burgos, Spain

    Jorge Labrador

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  1. David Martínez-Cuadrón
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Contributions

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 35, 1571–1585 (2021). https://doi.org/10.1038/s41375-020-01058-4

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