Disparities in AML Highlight Need for Tailored Strategies for Elderly Patients
Patients with AML aged 80 years and older face poor survival despite treatment advances, highlighting the need for improved, equitable care strategies and tailored treatment approaches.
Acute myeloid leukemia (AML) cells in blood flow: © LASZLO - stock.adobe.com
An analysis of the National Cancer Database showed that patients aged 80 years and older diagnosed with acute myeloid leukemia (AML) face significant barriers to treatment, as they are often ineligible for curative therapies like stem cell transplantation due to comorbidities, frailty, and the presence of high-risk genomic lesions.
Despite advancements in treatment options, survival outcomes showed there to be a median overall survival (mOS) of just 1.71 months (95% CI, 1.68-1.74), for this patient population according to the study. The research, which utilized data from 31,195 patients diagnosed between 2004 and 2021, found disparities in outcomes based on age, gender, ethnicity, insurance status, and treatment facility.
Survival in the trial was analyzed using Kaplan-Meier methods, with comparisons based on sociodemographic factors, treatment data, and facility type. Temporal trends in chemotherapy use and survival were evaluated using chi-squared tests and log-rank p-values.
Younger elderly patients aged 80 to 84 years had anmOS of 2.17 months (95% CI, 2.07-2.23) compared with 1.31 months for those aged 85 years and older (95% CI, 1.28-1.38; P <.01). Male patients had better survival outcomes compared with female patients, with anmOS of 1.84 months (95% CI, 1.77-1.90) vs 1.61 months(95% CI, 1.54-1.64), respectively (P <.01). Asian patients had the longest mOS at 2.40 months (95% CI, 2.00-3.06), vs 1.84 months (95% CI, 1.64-2.00) for Black patients, and 1.68 months (95% CI, 1.64-1.78) for non-Hispanic White patients (P <.01).
Insurance coverage also played a role, as Medicaid-insured patients experienced mOS (2.14 months; 95% CI, 1.71-2.83) vs uninsured individuals (1.38 months; 95% CI, 0.99-2.04) and those with Medicare (1.71 months; 95% CI, 1.64-1.74).
Overall, 46% of patients received chemotherapy, with 29% receiving multi-agent chemotherapy and 66% receiving single-agent regimens. Multi-agent chemotherapy yielded an mOS of 5.95 months compared with 3.38 months for single-agent therapy.
The study also revealed significant disparities in treatment delivery across facility types. Patients treated at academic or research centers were more likely to receive chemotherapy (59% vs 39% at community facilities) and had better outcomes, with an mOS of 2.33 months vs 1.48 months in community settings. Twelve patients underwent bone marrow transplantation, reaching an mOS of 15.57 months.
Looking at temporal trends, the mOS increased significantly over time, from 1.38 months in 2004-2008 to 2.00 months in 2019-2021. Chemotherapy use also grew from 35% of patients in 2004-2008 to 56% in 2019-2021. The use of multi-agent chemotherapy also reached 53% in the most recent period. Despite these promising results, the prognosis for very elderly patients with AML remains poor.
Based on these findings, experts suggest that future research should focus on refining treatment approaches for very elderly patients with AML, including optimizing patient selection for intensive therapies and exploring the long-term impact of newer regimens. The study also calls attention to the importance of improving access to specialized care to ensure that all patients, regardless of demographic or geographic factors, can benefit from advances in AML treatment.
