Outcome of older patients with acute myeloid leukemia: an analysis of SEER data over 3 decades

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.

Keywords: Surveillance, Epidemiology and End Results data; acute myeloid leukemia; age; survival.

Figure 1

a shows the number of patients diagnosed with AML by age group, gender and calendar period over the three decades. b shows the incidence of AML by age group, gender and calendar period over the three decades from 1977 to 2006.

Figure 1

a shows the number of patients diagnosed with AML by age group, gender and calendar period over the three decades. b shows the incidence of AML by age group, gender and calendar period over the three decades from 1977 to 2006.

Figure 2

a and b show the trends in five-year relative survival estimates for AML patients by gender (a: Male and b: Female) and three age groups (65–74, 75–84 and 85+ years) in nine Surveillance, Epidemiology, and End Results regions for 3 cohorts from 1977–2006. (Cohort I: 1977–1986, Cohort II: 1987–1996, Cohort III: 1997–2006) Improvement in survival was observed in patients age 65–74 years, but no improvements were seen in patients age >75 years.

Figure 2

a and b show the trends in five-year relative survival estimates for AML patients by gender (a: Male and b: Female) and three age groups (65–74, 75–84 and 85+ years) in nine Surveillance, Epidemiology, and End Results regions for 3 cohorts from 1977–2006. (Cohort I: 1977–1986, Cohort II: 1987–1996, Cohort III: 1997–2006) Improvement in survival was observed in patients age 65–74 years, but no improvements were seen in patients age >75 years.