Denutrition status prevails over a standard AML risk assessment in older adults

Abstract

Older adults with acute myeloid leukemia (AML) have a poor prognosis because frailty and the characteristics of the disease limit the use of intensive chemotherapy (ICT). Treatment with 5-azacitidine (5-AZA) or low-dose cytarabine (Cytarabine) (LDAC) - with or without venetoclax - is currently recommended in this setting. However, we lack real-life data on response rates and treatment outcomes. We conducted a retrospective, multicenter registry study of 279 older adults with AML (median [interquartile range (IQR)] age: 76 [70-81]) having undergone first-line treatment with LDAC (n = 87) or 5-AZA (n = 192) between 2009 and 2019 (i.e. mainly before the venetoclax era) in a university medical center in France. The complete remission rate was 27.3 % overall. After a median follow-up period of 6.9 months, the median [IQR] overall survival (OS) time was shorter in the LDAC group (4.8 months [2.13-14.41]) than in the 5-AZA group (8.9 months [3.2-13.5]; p = 0.046). Ultimately, however, the OS rates were similar in the LDAC and 5-AZA groups (hazard ratio [HR]: 95 % confidence interval [CI]: 1.37 [0.92-2.04], p = 0.12). None of the conventional markers with prognostic value in younger patients receiving ICT (such as those in the European LeukemiaNet classification) appeared to predict the outcome in our population of older patients. Albumin <30 g/L was the only factor that predicted day-30 mortality and OS (adjusted odds ratio [95 %CI]: 6.25 [2.08 - 20.0]; p < 0.001; adjusted HR [95 %CI]: 0.65 [0.44-0.96]; p = 0.030).

Keywords: Acute myeloid leukemia; Frail; Non-intensive chemotherapy; Unfit.