Epidemiological, genetic, and clinical characterization by age of newly diagnosed acute myeloid leukemia based on an academic population-based registry study (AMLSG BiO)

Abstract

We describe genetic and clinical characteristics of acute myeloid leukemia (AML) patients according to age from an academic population-based registry. Adult patients with newly diagnosed AML at 63 centers in Germany and Austria were followed within the AMLSG BiO registry (NCT01252485). Between January 1, 2012, and December 31, 2014, data of 3525 patients with AML (45% women) were collected. The median age was 65 years (range 18-94). The comparison of age-specific AML incidence rates with epidemiological cancer registries revealed excellent coverage in patients < 70 years old and good coverage up to the age of 80. The distribution according to the European LeukemiaNet (ELN) risk categorization from 2010 was 20% favorable, 31% intermediate-1, 28% intermediate-2, and 21% adverse. With increasing age, the relative but not the absolute prevalence of patients with ELN favorable and intermediate-1 risk (p < 0.001), with activating FLT3 mutations (p < 0.001), with ECOG performance status < 2 (p < 0.001), and with HCT-CI comorbidity index < 3 (p < 0.001) decreased. Regarding treatment, obesity and favorable risk were associated with an intensive treatment, whereas adverse risk, higher age, and comorbidity index > 0 were associated with non-intensive treatment or best supportive care. The AMLSG BiO registry provides reliable population-based distributions of genetic, clinical, and treatment characteristics according to age.

Keywords: AML; Epidemiology; Genetics; Older age; Registry.

Fig. 1

Incidence of AML 2012–2014 in the German AMLSG BiO registry (N = 3251) compared to selected German cancer registries and the US SEER program. AML in the cancer registries Bavaria, Saarland, and North Rhine-Westphalia (NRW) and US Surveillance, Epidemiology, and End Results (SEER) 2009–2013

Fig. 2

Distribution of AML subtypes (N, %) according to the WHO 2008 classification in 2740 patients. Abbreviations: CEBPA CCAAT/enhancer-binding protein alpha, N number of patients, NPM1 nucleophosmin-1

Fig. 3

a–d 2010 European LeukemiaNet (ELN) classification, HCT comorbidity index, performance status (ECOG), and FLT3 mutations by age classes in the AMLSG BiO registry (N = 3521). Abbreviations: ELN European LeukemiaNet, ECOG Eastern Cooperative Oncology Group performance status, FLT3 FMS-related tyrosine kinase 3, HCT hematopoietic cell transplantation, ITD internal tandem duplication, N number of patients, NPM1 nucleophosmin-1, TKD tyrosine kinase domain, WT wild type

Fig. 4

Frequency of treatment strategy (intensive, non-intensive and best supportive care (BSC)) according to age. Abbreviation: BSC, best supportive care ; N , number of patients