Acute Myeloid Leukemia in the elderly (age 70 years or older): long-term survivors

The incidence of Acute Myeloid Leukemia (AML) increases with age and the majority of cases occur in adults aged >55 years. Moreover, the prognosis of AML in older adults is largely poor and so, from the little data that exists, long-term survival rates for older patients with AML also tend to be low. Consequently, more data and knowledge are required to further develop therapeutic approaches that improve long-term survival in these patients.

Heiblig M. from the Lyon-Sud Hospital, France, and colleagues conducted an analysis of overall survival of at least three years to identify the number of long-term survivors and also define the factors that may contribute to longer survival. 57 patients with AML were eligible for this study.

The results were published in the European Journal of Haematology in September 2016. The authors emphasized that determining prognosis with cytogenetics before treatment is still of high importance, but noted that some patients with unfavorable-risk markers and/or secondary AML still achieved a long survival.

They concluded that individualized treatment approaches and supportive care are factors that could positively affect long-term survival in elderly patients with AML. Moreover, improved selection of these patients could produce improved results in long-term survival assessments.

Please see below for the full abstract:

 

ABSTRACT

OBJECTIVE: Little data exist regarding long-term survival in elderly patients with acute myeloid leukemia (AML).

 METHODS: In view of the fact that most deaths occurred during the first three years, the present study examined long-term survival in this patient population, defined as overall survival for at least 3 years with the aim to determine the number of long-term survivors and to identify factors that might impact on longer survival

RESULTS: The criterion for entry into this cohort was fulfilled by 57 patients among 302 seen over a 14-year period (19%): 12 patients who never achieved complete remission (CR), 21 patients who relapsed after CR achievement and 24 patients who achieved CR and did not relapse, including 3 patients who died while in CR and 21 patients still alive in first CR at the time of analysis. The pre-treatment prognostic importance of cytogenetics was still apparent. However, some patients with secondary AML and/or unfavorable-risk markers belonged to long survivors. The cohort involved mainly patients treated by intensive chemotherapy, but also some patients receiving low-intensity therapies

CONCLUSION: Improved results should come from a better selection of patients to a more 'personalized' therapeutic approach combined with better supportive care assessment.