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Clinical outcome of older adults with acute myeloid leukemia: an analysis of a large tertiary referral center over two decades

Item Type:Article
Title:Clinical outcome of older adults with acute myeloid leukemia: an analysis of a large tertiary referral center over two decades
Creators Name:Ihlow, J. and Gross, S. and Neuendorff, N.R. and Busack, L. and Herneth, A. and Singh, A. and Schwarz, M. and Flörcken, A. and Anagnostopoulos, I. and Türkmen, S. and Burmeister, T. and Blau, I.W. and Bullinger, L. and Westermann, J.
Abstract:OBJECTIVE: In older adults with acute myeloid leukemia (AML), the overall outcome is still dismal and long-term data on survival are scarce, particularly outside of clinical trials. Here, we assess characteristics, prognostic factors and long-term survival in patients ≥60 years who were treated for AML at our center over the past 17 years. METHODS: 590 older adults with newly diagnosed AML were characterized according to Eastern Cooperative Oncology Group (ECOG) score, Charlson comorbidity index (CCI), European LeukemiaNet (ELN) risk, type of therapy, serum ferritin (SF) and further baseline characteristics. Survival analysis was performed accordingly. RESULTS: Median age was 68 years and most patients were in good general condition. Median follow-up was 55.8 months. Of all patients, 66% received intensive chemotherapy (IC) +/- allogeneic hematopoietic stem cell transplantation (allo-HSCT). The remaining cohort received palliative chemotherapy (PC, 26%) or best supportive care only (BSC, 8%). Enrollment rate for interventional clinical trials was 26%. 5-year overall survival (OS) and relapse-free survival (RFS) were 18% (median 12.5 months) and 11,5% (median 10.0 months). Long-term survival was independently influenced by ECOG score, ELN risk group, baseline SF, previous myocardial infarction, and choice of therapy, but not consistently by age or CCI. Considering therapeutic subgroups, the contribution of particular parameters in predicting OS was most compelling in IC patients, but less consistent with PC or BSC. CONCLUSION: Our results provide thorough insights into prognostication within therapeutic subgroups and emphasize the need for more detailed prognostic algorithms and routine geriatric assessment in the treatment of older adults with AML.
Keywords:Acute Myeloid Leukemia, Older Patients with AML, Outcome, Prognostic Factors
Source:Journal of Geriatric Oncology
Page Range:540-549
Date:May 2021
Official Publication:https://doi.org/10.1016/j.jgo.2020.11.001
PubMed:View item in PubMed

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