Treatment patterns and comparative analysis of non-intensive regimens in elderly acute myeloid leukemia patients—a real-world experience from India

Kanakasetty, Govind Babu; Chethan, R.; Lakshmaiah, K C; Dasappa, Lokanatha; Jacob, Linu Abraham; C, Suresh Babu M; Lokesh, K N; Haleshappa, Rudresha Antapura; Rajeev, L K; Smitha, S.; Koppaka, Deepak; Patidar, Rajesh; Asati, Vikas

doi:10.1007/s00277-019-03600-6

Cited by 12 publications

(33 citation statements)

References 28 publications

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“…Ten studies addressed the comparison between less-intensive antileukemic therapy and best supportive care. 62,64,[88][89][90]92,[94][95][96][97] These studies provided evidence for mortality, hospitalization, and serious adverse events. The EtD framework for this recommendation is available online at https:// guidelines.gradepro.org/profile/Lfz8s2r0kpE and https://guidelines.…”

Section: Recommendationmentioning

confidence: 96%

“…A total of 15 studies were included in the evidence syntheses regarding benefits and harms for identified health outcomes. 62,64,[85][86][87][88][89][90][91][92][93][94][95][96][97] Eighteen additional studies were reviewed but excluded from the meta-analyses due to lack of data on the outcomes prioritized by the expert panel. [98][99][100][101][102][103][104][105][106][107][108][109][110][111][112][113][114][115][116] Given the challenges in randomizing patients to intensive or less-intensive treatments, most of the included studies were observational.…”

Section: Recommendationmentioning

confidence: 99%

“…[98][99][100][101][102][103][104][105][106][107][108][109][110][111][112][113][114][115][116] Given the challenges in randomizing patients to intensive or less-intensive treatments, most of the included studies were observational. 62,85,86,93,95,96 Two were randomized clinical trials (RCTs). 94,96 One study was an RCT 64 in which patients were preselected by their physicians as appropriate candidates for either intensive therapy, less-intensive therapy, or best supportive care and then randomized to their preselected conventional-care treatment or to azacitidine.…”

Section: Recommendationmentioning

confidence: 99%

“…62,85,86,93,95,96 Two were randomized clinical trials (RCTs). 94,96 One study was an RCT 64 in which patients were preselected by their physicians as appropriate candidates for either intensive therapy, less-intensive therapy, or best supportive care and then randomized to their preselected conventional-care treatment or to azacitidine. Within this study, patients preselected for less-intensive therapy and then randomized to receive azacitidine or best supportive care were used for RCT data in our analyses.…”

Section: Recommendationmentioning

confidence: 99%

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American Society of Hematology 2020 guidelines for treating newly diagnosed acute myeloid leukemia in older adults

et al. 2020

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Background: Older adults with acute myeloid leukemia (AML) represent a vulnerable population in whom disease-based and clinical risk factors, patient goals, prognosis, and practitioner- and patient-perceived treatment risks and benefits influence treatment recommendations. Objective: These evidence-based guidelines of the American Society of Hematology (ASH) are intended to support patients, clinicians, and other health care professionals in their decisions about management of AML in older adults. Methods: ASH formed a multidisciplinary guideline panel that included specialists in myeloid leukemia, geriatric oncology, patient-reported outcomes and decision-making, frailty, epidemiology, and methodology, as well as patients. The McMaster Grading of Recommendations Assessment, Development and Evaluation (GRADE) Centre supported the guideline-development process, including performing systematic evidence reviews (up to 24 May 2019). The panel prioritized clinical questions and outcomes according to their importance to patients, as judged by the panel. The panel used the GRADE approach, including GRADE’s Evidence-to-Decision frameworks, to assess evidence and make recommendations, which were subject to public comment. Results: The panel agreed on 6 critical questions in managing older adults with AML, mirroring real-time practitioner-patient conversations: the decision to pursue antileukemic treatment vs best supportive management, the intensity of therapy, the role and duration of postremission therapy, combination vs monotherapy for induction and beyond, duration of less-intensive therapy, and the role of transfusion support for patients no longer receiving antileukemic therapy. Conclusions: Treatment is recommended over best supportive management. More-intensive therapy is recommended over less-intensive therapy when deemed tolerable. However, these recommendations are guided by the principle that throughout a patient’s disease course, optimal care involves ongoing discussions between clinicians and patients, continuously addressing goals of care and the relative risk-benefit balance of treatment.

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Section: Recommendationmentioning

confidence: 96%

Section: Recommendationmentioning

confidence: 99%

Section: Recommendationmentioning

confidence: 99%

Section: Recommendationmentioning

confidence: 99%

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American Society of Hematology 2020 guidelines for treating newly diagnosed acute myeloid leukemia in older adults

et al. 2020

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“…The reported survival was 3.9, 6.4, and 1.2 months with LDAC, HMA, or BSC, respectively. The remaining patients, 213 (53.3%) refused care [46].…”

Section: Barriers To Access To Therapy In Developing Countriesmentioning

confidence: 99%

Access to Therapy for Acute Myeloid Leukemia in the Developing World: Barriers and Solutions

Meillón-Garcı́a

Demichelis‐Gómez

2020

Curr Oncol Rep

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Purpose of Review Acute myeloid leukemia (AML) is a costly disease, and its impact is greater in developing countries (DC). We will review the current concept of what are DC, compare the differences in the epidemiology and economic burden of this disease between developed and DC, and finally, analyze the barriers and possible solutions that DC should implement to achieve better results. Recent Findings DC is a frequently misunderstood name. The way we use to measure human development is changing, and multidimension metrics better define what are DC. With this in mind, we show the differences in the AML epidemiology and the impact of economic burden in DC. We analyze the barriers to access therapy from a clinician point of view, to show that most DC shared similar challenges but with a diverse healthcare structure. Finally, we provide several possible solutions for a more integrated and timely treatment that allows better results not only in terms of survival but with a better quality of life. Summary The economic burden of AML treatment in DC is high, and the results are poor. It is crucial to face this challenge and propose new treatment approaches to achieve better results.

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Patterns of undertreatment among patients with acute myeloid leukemia (AML): considerations for patients eligible for non-intensive chemotherapy (NIC)

Hubscher

Sikirica

Bell

et al. 2021

J Cancer Res Clin Oncol

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Acute myeloid leukemia (AML) is a life-threatening malignancy that is more prevalent in the elderly. Because the patient population is heterogenous and advanced in age, choosing the optimal therapy can be challenging. There is strong evidence supporting antileukemic therapy, including standard intensive induction chemotherapy (IC) and non-intensive chemotherapy (NIC), for older patients with AML, and guidelines recommend treatment selection based on a patient’s individual and disease characteristics as opposed to age alone. Nonetheless, historic evidence indicates that a high proportion of patients who may be candidates for NIC receive no active antileukemic treatment (NAAT), instead receiving only best supportive care (BSC). We conducted a focused literature review to assess current real-world patterns of undertreatment in AML. From a total of 25 identified studies reporting the proportion of patients with AML receiving NAAT, the proportion of patients treated with NAAT varied widely, ranging from 10 to 61.4% in the US and 24.1 to 35% in Europe. Characteristics associated with receipt of NAAT included clinical factors such as age, poor performance status, comorbidities, and uncontrolled concomitant conditions, as well as sociodemographic factors such as female sex, unmarried status, and lower income. Survival was diminished among patients receiving NAAT, with reported median overall survival values ranging from 1.2 to 4.8 months compared to 5 to 14.4 months with NIC. These findings suggest a proportion of patients who are candidates for NIC receive NAAT, potentially forfeiting the survival benefit of active antileukemic treatment.

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Treatment patterns and comparative analysis of non-intensive regimens in elderly acute myeloid leukemia patients—a real-world experience from India

Cited by 12 publications

References 28 publications

American Society of Hematology 2020 guidelines for treating newly diagnosed acute myeloid leukemia in older adults

American Society of Hematology 2020 guidelines for treating newly diagnosed acute myeloid leukemia in older adults

Access to Therapy for Acute Myeloid Leukemia in the Developing World: Barriers and Solutions

Patterns of undertreatment among patients with acute myeloid leukemia (AML): considerations for patients eligible for non-intensive chemotherapy (NIC)

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