Revisiting the Real-World Prognosis of Intensive Chemotherapy in Elderly Acute Myeloid Leukemia Patients: A Retrospective Analysis from Tokyo

We investigated whether reduced intensity-chemotherapy (IC) is associated with decreased toxicity and longer overall survival (OS) in elderly AML patients. Age-dependent dose-reduced IC was administered to 110 AML patients between 2004 and 2021. We assessed myelosuppressive toxicity, clinical efficacy, and safety of our regimen using the depth index (D-index). Patients of 66–79 years of age (younger elderly [YE], n = 52) and ≥ 80 years (older elderly [OE], n = 19) were compared to a control group of patients of ≤ 65 years of age (n = 39). Although no significant differences were observed in the number of days with neutrophil count < 500/µl, the D-index, or the onset of sepsis among the groups, OS significantly differed (median OS: control, 578 days [317 days-NA]; YE, 281 days [158–515 days]; OE, 185 days [72–373 days]; p = 0.0001). IC for elderly AML patients achieved negative treatment outcomes despite a reduction in myelosuppressive toxicity, with no data beyond a median OS of 14.7 months for Azacytidine + Venetoclax therapy in a phase 3 VIALE-A trial. Although the findings were negative, the present results provide insights into appropriate IC regimens for elderly AML patients in the future.