Neil Dhopeshwarkar1, Shahed Iqbal2, Xuehong Wang3, Maribel Salas4. 1. Clinical Safety and Pharmacovigilance and Epidemiology, Daiichi Sankyo Inc, Basking Ridge, NJ; College of Pharmacy and Health Sciences, St John's University, Queens, NY. 2. Clinical Safety and Pharmacovigilance and Epidemiology, Daiichi Sankyo Inc, Basking Ridge, NJ. 3. Clinical Safety and Pharmacovigilance and Epidemiology, Daiichi Sankyo Inc, Basking Ridge, NJ; PRO Unlimited, Burlingame, CA. 4. Clinical Safety and Pharmacovigilance and Epidemiology, Daiichi Sankyo Inc, Basking Ridge, NJ; Center of Clinical Epidemiology and Biostatistics (CCEB) and Center for Pharmacoepidemiology Research and Training (CPeRT), University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA. Electronic address: msalas@dsi.com.
Abstract
BACKGROUND: Comorbidities in acute myeloid leukemia (AML) patients have been shown to increase with age. However, few studies have described the disease burden in elderly AML patients, a population generally underrepresented in clinical trials. We aimed to characterize the comorbidities and complications in elderly AML patients. PATIENTS AND METHODS: Patients aged ≥ 65 years with a primary diagnosis of AML were identified from the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database (2000-2013) and were followed until the end of 2014. AML patients were matched 1:1 to noncancer patients by age, sex, geographic region, and race. A subset of patients with relapsed and/or refractory (R/R) AML was identified by modifying a previously validated algorithm. Baseline comorbidities and complications (eg, infectious, hematologic, cardiovascular) during follow-up were assessed using ICD-9 codes. Cox proportional hazards models were used to determine associations between AML and developing select complications. RESULTS: Compared to matched noncancer controls, AML patients (n = 3911) had higher baseline National Cancer Institute comorbidity index scores (1.81 vs. 1.63, P < .01), higher incidence rates (per 100 person-years) for all events of interest, and a higher risk of developing cardiovascular disease (hazard ratio = 4.61; 95% confidence interval, 4.07-5.21), type 2 diabetes mellitus (hazard ratio = 3.85; 95% confidence interval, 3.35-4.42), and stroke (hazard ratio = 2.60; 95% confidence interval, 2.32-2.92). R/R AML patients were younger, had lower National Cancer Institute comorbidity scores, lower incidence rates of events of interest, and a longer follow-up time compared to non-R/R AML patients. CONCLUSION: Elderly AML patients had more comorbidities and higher rates of complications compared to noncancer controls. Considering comorbidities and complications in elderly AML patients may improve clinical decision making.
BACKGROUND: Comorbidities in acute myeloid leukemia (AML) patients have been shown to increase with age. However, few studies have described the disease burden in elderly AMLpatients, a population generally underrepresented in clinical trials. We aimed to characterize the comorbidities and complications in elderly AMLpatients. PATIENTS AND METHODS: Patients aged ≥ 65 years with a primary diagnosis of AML were identified from the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database (2000-2013) and were followed until the end of 2014. AMLpatients were matched 1:1 to noncancer patients by age, sex, geographic region, and race. A subset of patients with relapsed and/or refractory (R/R) AML was identified by modifying a previously validated algorithm. Baseline comorbidities and complications (eg, infectious, hematologic, cardiovascular) during follow-up were assessed using ICD-9 codes. Cox proportional hazards models were used to determine associations between AML and developing select complications. RESULTS: Compared to matched noncancer controls, AMLpatients (n = 3911) had higher baseline National Cancer Institute comorbidity index scores (1.81 vs. 1.63, P < .01), higher incidence rates (per 100 person-years) for all events of interest, and a higher risk of developing cardiovascular disease (hazard ratio = 4.61; 95% confidence interval, 4.07-5.21), type 2 diabetes mellitus (hazard ratio = 3.85; 95% confidence interval, 3.35-4.42), and stroke (hazard ratio = 2.60; 95% confidence interval, 2.32-2.92). R/R AMLpatients were younger, had lower National Cancer Institute comorbidity scores, lower incidence rates of events of interest, and a longer follow-up time compared to non-R/R AMLpatients. CONCLUSION: Elderly AMLpatients had more comorbidities and higher rates of complications compared to noncancer controls. Considering comorbidities and complications in elderly AMLpatients may improve clinical decision making.
Authors: Ara Jo; Lisa Scarton; LaToya J O'Neal; Samantha Larson; Nancy Schafer; Thomas J George; Juan M Munoz Pena Journal: Cancer Med Date: 2020-12-23 Impact factor: 4.452
Authors: Nina Rosa Neuendorff; Kah Poh Loh; Alice S Mims; Konstantinos Christofyllakis; Wee-Kheng Soo; Bediha Bölükbasi; Carlos Oñoro-Algar; William G Hundley; Heidi D Klepin Journal: Blood Adv Date: 2020-02-25