Burak Kalin1, Esther N Pijnappel2, Michel van Gelder2, Otto Visser3, Arjan A van de Loosdrecht4, Gert J Ossenkoppele4, Jan J Cornelissen1, Avinash G Dinmohamed5, Mojca Jongen-Lavrencic6. 1. Erasmus MC Cancer Institute, Department of Hematology, Rotterdam, the Netherlands. 2. Department of Internal Medicine, Division of Hematology, Maastricht University Medical Center, Maastricht, the Netherlands. 3. Department of Registration, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands. 4. Department of Hematology, VU University Medical Center, Cancer Center Amsterdam, Amsterdam, the Netherlands. 5. Erasmus MC Cancer Institute, Department of Hematology, Rotterdam, the Netherlands; Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands; Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands. Electronic address: a.dinmohamed@iknl.nl. 6. Erasmus MC Cancer Institute, Department of Hematology, Rotterdam, the Netherlands. Electronic address: m.lavrencic@erasmusmc.nl.
Abstract
BACKGROUND: The paucity of population-based research indicates that the application of intensive chemotherapy (ICT) among elderly acute myeloid leukemia (AML) patients, as well as their accrual to randomized controlled trials (RCTs) remains low for several decades. Therefore, a contemporary, comprehensive apprehension on patient-, disease-, and treatment-specific characteristics of elderly AML patients at the population level can inform treatment choices and facilitate increased patient accrual in upcoming RCTs. OBJECTIVES: In this population-based study, we investigated patient- and disease-specific characteristics in elderly AML patients, and their association with treatment and survival. METHODS: We retrospectively obtained data on all over 65-year-old AML patients diagnosed between 2010-2013 in the referral area of two university hospitals in the Netherlands. Multivariable analyses were performed to assess factors associated with treatment choice and overall survival. RESULTS: Of all 356 patients, 77% received non-intensive therapy (NIT), and 15% and 8% received ICT within and outside a RCT, respectively. Cytogenetic (74%) and molecular (93%) analyses were not performed in most NIT recipients. Age and comorbidity were independently associated with NIT, whereas only comorbidity was associated with decreased trial participation. The adjusted risk of mortality among ICT recipients was not influenced by trial participation status. CONCLUSION: The application of ICT and accrual to RCTs remains staggeringly low in an elderly AML population. Since survival of ICT-treated patients was not affected by trial participation status, exclusion criteria might be relaxed in upcoming RCTs. Furthermore, appropriate management strategies can be accomplished by comprehensive comorbidity assessment and augmented genetic prognostication.
BACKGROUND: The paucity of population-based research indicates that the application of intensive chemotherapy (ICT) among elderly acute myeloid leukemia (AML) patients, as well as their accrual to randomized controlled trials (RCTs) remains low for several decades. Therefore, a contemporary, comprehensive apprehension on patient-, disease-, and treatment-specific characteristics of elderly AMLpatients at the population level can inform treatment choices and facilitate increased patient accrual in upcoming RCTs. OBJECTIVES: In this population-based study, we investigated patient- and disease-specific characteristics in elderly AMLpatients, and their association with treatment and survival. METHODS: We retrospectively obtained data on all over 65-year-old AMLpatients diagnosed between 2010-2013 in the referral area of two university hospitals in the Netherlands. Multivariable analyses were performed to assess factors associated with treatment choice and overall survival. RESULTS: Of all 356 patients, 77% received non-intensive therapy (NIT), and 15% and 8% received ICT within and outside a RCT, respectively. Cytogenetic (74%) and molecular (93%) analyses were not performed in most NIT recipients. Age and comorbidity were independently associated with NIT, whereas only comorbidity was associated with decreased trial participation. The adjusted risk of mortality among ICT recipients was not influenced by trial participation status. CONCLUSION: The application of ICT and accrual to RCTs remains staggeringly low in an elderly AML population. Since survival of ICT-treated patients was not affected by trial participation status, exclusion criteria might be relaxed in upcoming RCTs. Furthermore, appropriate management strategies can be accomplished by comprehensive comorbidity assessment and augmented genetic prognostication.
Authors: Christopher R D'Angelo; Aric Hall; Kaitlin M Woo; KyungMann Kim; Walter Longo; Peiman Hematti; Natalie Callander; Vaishalee P Kenkre; Ryan Mattison; Mark Juckett Journal: Leuk Res Date: 2020-07-08 Impact factor: 3.156
Authors: Vijaya R Bhatt; Valerie Shostrom; Sarah A Holstein; Zaid S Al-Kadhimi; Lori J Maness; Ann Berger; James O Armitage; Krishna Gundabolu Journal: Clin Lymphoma Myeloma Leuk Date: 2020-02-04
Authors: David Martínez-Cuadrón; Josefina Serrano; Cristina Gil; Mar Tormo; Pilar Martínez-Sánchez; José A Pérez-Simón; Raimundo García-Boyero; Carlos Rodríguez-Medina; María López-Pavía; Celina Benavente; Juan Bergua; Esperanza Lavilla-Rubira; María L Amigo; Pilar Herrera; Juan M Alonso-Domínguez; Teresa Bernal; Mercedes Colorado; María J Sayas; Lorenzo Algarra; María B Vidriales; Gabriela Rodríguez-Macías; Susana Vives; Manuel M Pérez-Encinas; Aurelio López; Víctor Noriega; María García-Fortes; Fernando Ramos; Juan I Rodríguez-Gutiérrez; Lisette Costilla-Barriga; Jorge Labrador; Blanca Boluda; Rebeca Rodríguez-Veiga; Joaquín Martínez-López; Miguel A Sanz; Pau Montesinos Journal: Leukemia Date: 2020-10-19 Impact factor: 11.528