Outcome of Older Patients With Acute Myeloid Leukemia: An Analysis of SEER Data Over 3 Decades

• Published in: Cancer Vol. 119; no. 15; pp. 2720 - 2727
• Main Authors: THEIN, Mya S, ERSHLER, William B, JEMAL, Ahmedin, YATES, Jerome W, BAER, Maria R
• Format: Journal Article
• Language: English
• Published: Hoboken, NJ Wiley-Blackwell 01.08.2013
• Subjects: Age Factors; Aged; Biological and medical sciences; Female; Hematologic and hematopoietic diseases; Humans; Incidence; Leukemia, Myeloid, Acute - drug therapy; Leukemia, Myeloid, Acute - mortality; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Male; Medical sciences; SEER Program; Survival Rate - trends; Treatment Outcome; Tumors; United States - epidemiology; United States; Human; Data analysis; Acute myelogenous leukemia; Prognosis; Malignant hemopathy; Epidemiology; Survival; Epidemiology and End Results data; Cancerology; Surveillance; acute myeloid leukemia; Evolution; Elderly; Age; Cancer; age; Surveillance, Epidemiology and End Results data; survival
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/cncr.28129

Acute myeloid leukemia (AML) is the common form of acute leukemia in adults, accounting for over 80% of all acute leukemias in individuals aged >18 years. Overall 5-year survival remains poor in older AML patients; it is <5% in patients aged >65 years. In this study, the authors examined whether survival has improved for subsets of geriatric AML patients over 3 successive decades. Surveillance, Epidemiology and End Results (SEER) data were used to determine trends in relative survival by age among 19,000 patients with AML over 3 successive decades (1977-1986, 1987-1996, and 1997-2006). Relative survival rates (RRs) with 95% confidence intervals (CIs) were calculated as measures of survival. Overall, the RRs increased for each successive decade (1977-1986, 1987-1996, and 1997-2006) in patients ages 65 to 74 years, with improvements in 12-month survival from 20%, to 25%, to 30%, respectively. Findings were similar for 24-month, 36-month, 48-month, and 60-month survival. However, survival rates did not improve in patients aged ≥75 years. The oldest old patients (aged ≥85 years) had the lowest survival rates, with no apparent improvement. This analysis of a large data set demonstrated that, although overall survival remained unsatisfactory among older patients, it improved in the younger old (ages 65-74 years). Survival of older old AML patients has not been favorably impacted by available AML therapies or supportive care, and intervention in this age group is best undertaken on a clinical trial.