A new analysis of overall survival (OS) data for acute myeloid leukemia (AML) revealed “high unmet need and dismal long-term OS”, particularly in older patients.
The study looked at 15,646 patients with AML from the National Cancer Database. Of these, 40% were aged 18 to 59. Among those patients with available 10-year follow-up, the 10-year OS was 13% for patients aged 18 to 59 treated with chemotherapy alone and only 8% for patients aged 55 to 59.
Ten-year OS improved to 24% for patients aged 18 to 59 and to 16% for patients aged 55 to 59 treated with chemotherapy and upfront transplant. Among patients aged 60 or older, the 10-year OS was 2% with chemotherapy alone and 16% with chemotherapy and upfront transplant.
The researchers performed a multivariate logistic regression model and found that patients aged 18 to 59 treated with chemotherapy were more likely to survive at 10 years if they were younger, female, or had CBF AML. Additionally, survival was affected by higher income and private insurance. Similarly, patients aged 18 to 59 treated with chemotherapy and upfront transplant were more likely to survive at 10 years if they were younger and had private insurance.
The likelihood of death increase with increasing age. In addition to age, increasing comorbidities, treatment at a non-academic centers, insurance other than private, and use of single-agent chemotherapy were all associated with higher likelihood of mortality.
“Recent advances and approval of nine new drugs will likely improve short-term OS at 2–3 years,” the researchers wrote. “However, improving long-term OS is challenging and will likely require innovative strategies such as incorporating effective multiagent combination chemotherapy as a part of upfront treatment, precision oncology approach, increased use of reduced-intensity allogeneic stem cell transplant, and effective use of maintenance therapies.”