Age and acute myeloid leukemia: real world data on decision to treat and outcomes from the Swedish Acute Leukemia Registry

Juliusson, Gunnar; Antunović, Petar; Derolf, Åsa Rangert; Lehmann, Sören; Möllgård, Lars; Stockelberg, Dick; Tidefelt, Ulf; Wåhlin, Anders; Höglund, Martin

doi:10.1182/blood-2008-07-172007

Cited by 835 publications

(720 citation statements)

References 35 publications

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“…Currently, there is no consensus on the optimal treatment for older patients with AML. Epidemiological and clinical studies have consistently demonstrated that AML patients up to 80 years old who are treated with intensive induction chemotherapy survive significantly longer than individuals receiving palliative care [39,40]. Despite this, many older individuals continue to be offered only low intensity or best supportive care due to concerns about treatment-related mortality and morbidity with intensive regimens.…”

Section: Discussionmentioning

confidence: 99%

Comparison of epigenetic versus standard induction chemotherapy for newly diagnosed acute myeloid leukemia patients ≥60 years old

et al. 2015

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Older patients with acute myeloid leukemia (AML) have poor outcomes with standard induction chemotherapy. We retrospectively reviewed our institute's experience with epigenetic (Epi) versus cytarabine-and anthracycline-based intensive chemotherapy (IC) as induction in newly diagnosed AML patients aged 60 years and older. One hundred sixty-seven patients (n 5 84, IC; n 5 83, Epi) were assessed; 69 patients received decitabine and 14 azacitidine. Baseline characteristics between the IC and Epi patient cohorts were not statistically different except for age, initial white blood cell count, and comorbidity index. Overall response rate (ORR, 50% vs. 28%, respectively, P < 0.01) and complete response rate (CRR, 43% vs. 20%, respectively, P < 0.01) were superior following IC vs. Epi. Although univariate analysis demonstrated longer overall survival after IC (10.7 vs. 9.1 months, P 5 0.012), multivariate analysis showed no independent impact of induction treatment. Treatment-related mortality was not statistically different in the two groups. Outcomes of patients with secondary, poor cytogenetic risk, FLT-3 mutated AML, or relapsed/refractory disease after IC or Epi were not significantly different. Outcomes of patients receiving IC versus a 10-day decitabine regimen (n 5 63) also were not significantly different. Our results suggest that IC and Epi therapy are clinically equivalent approaches for upfront treatment of older patients with AML and that other factors (feasibility, toxicity, cost, etc.) should drive treatment decisions. Prospective randomized trials to determine the optimal induction approach for specific patient subsets are needed.

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Section: Discussionmentioning

confidence: 99%

Comparison of epigenetic versus standard induction chemotherapy for newly diagnosed acute myeloid leukemia patients ≥60 years old

et al. 2015

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“…This might explain, why our 5-year overall survival rate of 38.3% is higher than in previously published reports such as the US cancer registry (24.9%) [1]. A Swedish registry study showed a decrease in 5-year overall survival with every 5-years of age increase (<50 years: 51%, 50-54 years: 40%, 55-59 years: 23%, 60-64 years: 23%, 65-69 years: 13%, 70-74 years: 5%, 75-79 years: 3%, 80-84 years: 2%, ≥85 years: 0%) [16].…”

Section: Discussionmentioning

confidence: 99%

Flow cytometric maturity score as a novel prognostic parameter in patients with acute myeloid leukemia

et al. 2015

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Abstract:The European LeukemiaNet (ELN) classification is widely accepted for risk stratification of patients with acute myeloid leukemia (AML). In order to establish immunophenotypic features that predict prognosis, the expression of single AML blast cell antigens has been evaluated with partly conflicting results; however, the influence of immunophenotypic blast maturity is largely unknown.In our study, 300 AML patients diagnosed at our institution between 01/2003 and 04/2012 were analyzed. A flow cytometric maturity score was developed in order to distinguish "mature" AML (AML-ma) from "immature" AML (AML-im) by quantitative expression levels of early progenitor cell antigens (CD34, CD117, and TdT).AML-ma showed significantly longer relapse-free survival (RFS) and overall survival (OS) than AML-im (p<0.001). Interestingly, statistically significant differences in RFS and OS were maintained within the Our novel flow cytometric score easily determines AML blast maturity and can predict clinical outcome. It remains to be clarified whether these results simply reflect an accumulation of favorable molecular phenotypes in the AML-ma subgroup or whether they rely on biological differences such as a higher proportion of leukemia stem cells and/or a higher degree of genetic instability within the AML-im subgroup.

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“…The registry is nationwide for a total population of 9 million. For the studied period, the coverage was 98%, when compared with the Swedish Cancer Registry, which is a compulsory reporting system where both the clinician and the pathologist are obliged by law to report all newly diagnosed cancer patients [9]. Data reported to the Swedish Acute Leukemia Registry include (among other data) date of diagnosis, age, gender, FAB type, cytogenetics [10], diagnostic procedures, performance status (PS), presence of antecedent hematological or other malignant disorder, type of treatment (i.e., chemotherapy or radiation) for the preceding disease, type of treatment for AML (intensive or palliative), CR date, and information on hematopoietic stem cell transplantation.…”

Section: Methodsmentioning

confidence: 99%

“…To better characterize secondary AML in comparison to de novo AML and to evaluate its role as a prognostic factor in a population-based setting, we conducted an analysis of all 3,363 adult AML patients diagnosed between 1997 and 2006 reported to the population-based Swedish AMLregistry [9]. As AHD-AML and t-AML represent separate entities, these subgroups were also analyzed separately and compared.…”

Section: Introductionmentioning

confidence: 99%

Characterization and prognostic features of secondary acute myeloid leukemia in a population‐based setting: A report from the Swedish Acute Leukemia Registry

et al. 2015

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Patients with secondary acute myeloid leukemia (AML) often escape inclusion in clinical trials and thus, population-based studies are crucial for its accurate characterization. In this first large population-based study on secondary AML, we studied AML with an antecedent hematological disease (AHD-AML) or therapyrelated AML (t-AML) in the population-based Swedish Acute Leukemia Registry. The study included 3,363 adult patients of which 2,474 (73.6%) had de novo AML, 630 (18.7%) AHD-AML, and 259 (7.7%) t-AML. Secondary AML differed significantly compared to de novo AML with respect to age, gender, and cytogenetic risk. Complete remission (CR) rates were significantly lower but early death rates similar in secondary AML. In a multivariable analysis, AHD-AML (HR 1.51; 95% CI 1.26-1.79) and t-AML (1.72; 1.38-2.15) were independent risk factors for poor survival. The negative impact of AHD-AML and t-AML on survival was highly age dependent with a considerable impact in younger patients, but without independent prognostic value in the elderly. Although patients with secondary leukemia did poorly with intensive treatment, early death rates and survival were significantly worse with palliative treatment. We conclude that secondary AML in a population-based setting has a striking impact on survival in younger AML patients, whereas it lacks prognostic value among the elderly patients.

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Age and acute myeloid leukemia: real world data on decision to treat and outcomes from the Swedish Acute Leukemia Registry

Cited by 835 publications

References 35 publications

Comparison of epigenetic versus standard induction chemotherapy for newly diagnosed acute myeloid leukemia patients ≥60 years old

Comparison of epigenetic versus standard induction chemotherapy for newly diagnosed acute myeloid leukemia patients ≥60 years old

Flow cytometric maturity score as a novel prognostic parameter in patients with acute myeloid leukemia

Characterization and prognostic features of secondary acute myeloid leukemia in a population‐based setting: A report from the Swedish Acute Leukemia Registry

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