Characteristics, outcomes and health care utilization of patients with acute myeloid leukemia aged 70 years or older: A single-center retrospective analysis

IF 3.3 4区医学 Q2 HEMATOLOGY Hematological Oncology Pub Date : 2024-08-13 DOI:10.1002/hon.3300

Marie Anne-Catherine Neumann, Jan-Hendrik Naendrup, Jorge Garcia Borrega, Ismini Halmer, Lisa Altenrath, Noelle Sieg, Michael Hallek, Dennis A. Eichenauer, Jan-Michel Heger

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Abstract

The overall prognosis of older patients with acute myeloid leukemia (AML) is dismal. Only a small subgroup experiences long-term survival. The discrimination between patients who are candidates for potentially curative approaches and those who are not is crucial since - in addition to differences in terms of AML-directed treatment - different policies concerning intensive care unit (ICU) admission and involvement of specialized palliative care (SPC) seem obvious. To shed more light on characteristics, outcomes and health care utilization of older individuals with AML, we conducted an analysis comprising 107 consecutive patients with newly diagnosed AML aged ≥70 years treated at an academic tertiary care center in Germany between 1 January 2015, and 31 December 2020. Median age was 75 years (range: 70–87 years); 45% of patients were female. The proportion of patients receiving intensive induction chemotherapy was 35%, 55% had low-intensity treatment and 10% did not receive AML-directed treatment or follow-up ended before treatment initiation. At least one ICU admission was documented for 47% of patients; SPC was involved in 43% of cases. Median follow-up was 199 days. The median overall survival (OS) was 2.5 months; the 1-year OS rate was 16%. Among patients who died during observation, the median proportion of time spent in the hospital between AML diagnosis and death was 56%. The most common places of death were normal wards (31%) and the ICU (28%). Patients less frequently died in a palliative care unit (14%) or at home (12%). In summary, results of the present analysis confirm the unfavorable prognosis of older patients with AML despite intensive health care utilization. Future efforts in this patient group should aim at optimizing the balance between appropriate AML-directed treatment on the one hand and health care utilization including ICU stays on the other hand.

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70 岁或 70 岁以上急性髓性白血病患者的特征、预后和医疗服务使用情况：单中心回顾性分析。

老年急性髓性白血病（AML）患者的总体预后令人沮丧。只有一小部分患者能够长期存活。除了急性髓性白血病治疗方面的差异外，有关重症监护病房（ICU）的入院和专业姑息治疗（SPC）的不同政策似乎也显而易见，因此，区分哪些患者适合采用潜在的治疗方法，哪些患者不适合采用潜在的治疗方法至关重要。为了进一步了解老年急性髓细胞性白血病患者的特征、预后和医疗服务利用情况，我们对2015年1月1日至2020年12月31日期间在德国一家学术性三级医疗中心接受治疗的107例新确诊急性髓细胞性白血病连续患者进行了分析。中位年龄为 75 岁（范围：70-87 岁）；45% 的患者为女性。接受强化诱导化疗的患者比例为35%，55%的患者接受了低强度治疗，10%的患者在开始治疗前未接受AML定向治疗或随访结束。47%的患者至少有一次入住重症监护室的记录；43%的病例涉及SPC。随访中位数为 199 天。中位总生存期（OS）为2.5个月；1年OS率为16%。在观察期间死亡的患者中，从确诊急性髓细胞性白血病到死亡的住院时间中位数比例为56%。最常见的死亡地点是普通病房（31%）和重症监护室（28%）。患者较少死于姑息治疗病房（14%）或家中（12%）。总之，本分析结果证实，尽管老年急性髓细胞性白血病患者使用了大量医疗服务，但其预后仍不容乐观。今后，针对这一患者群体的工作应着眼于优化适当的急性髓细胞性白血病定向治疗与包括重症监护病房在内的医疗服务利用率之间的平衡。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Hematological Oncology 医学-血液学

CiteScore

4.20

自引率

6.10%

发文量

147

审稿时长

>12 weeks

期刊介绍： Hematological Oncology considers for publication articles dealing with experimental and clinical aspects of neoplastic diseases of the hemopoietic and lymphoid systems and relevant related matters. Translational studies applying basic science to clinical issues are particularly welcomed. Manuscripts dealing with the following areas are encouraged: -Clinical practice and management of hematological neoplasia, including: acute and chronic leukemias, malignant lymphomas, myeloproliferative disorders -Diagnostic investigations, including imaging and laboratory assays -Epidemiology, pathology and pathobiology of hematological neoplasia of hematological diseases -Therapeutic issues including Phase 1, 2 or 3 trials as well as allogeneic and autologous stem cell transplantation studies -Aspects of the cell biology, molecular biology, molecular genetics and cytogenetics of normal or diseased hematopoeisis and lymphopoiesis, including stem cells and cytokines and other regulatory systems. Concise, topical review material is welcomed, especially if it makes new concepts and ideas accessible to a wider community. Proposals for review material may be discussed with the Editor-in-Chief. Collections of case material and case reports will be considered only if they have broader scientific or clinical relevance.