Outcome of older patients with acute myeloid leukemia

An Analysis of SEER Data Over 3 Decades

Authors

  • Mya S. Thein MD,

    1. Division of Hematology/Oncology, University of Maryland School of Medicine and University of Maryland Greenebaum Cancer Center, Baltimore, Maryland
    2. Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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  • William B. Ershler MD,

    1. Institute for Advanced Studies in Aging, Falls Church, Virginia
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  • Ahmedin Jemal DVM, PhD,

    1. American Cancer Society, Atlanta, Georgia
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  • Jerome W. Yates MD,

    1. Institute for Advanced Studies in Aging, Falls Church, Virginia
    2. Roswell Park Cancer Institute, Department of Medicine, Buffalo, New York
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  • Maria R. Baer MD

    Corresponding author
    1. Division of Hematology/Oncology, University of Maryland School of Medicine and University of Maryland Greenebaum Cancer Center, Baltimore, Maryland
    • Corresponding author: Maria R. Baer, MD, University of Maryland Greenebaum Cancer Center, 22 South Greene Street, Baltimore, MD 21201; Fax: (410) 328-6896; mbaer@umm.edu

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Abstract

BACKGROUND

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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. Cancer 2013;119:2720–2727. © 2013 American Cancer Society.

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