Abstract
Less-intensive induction therapies are increasingly used in older patients with acute myeloid leukemia (AML). Using an AML composite model (AML-CM) assigning higher scores to older age, increased comorbidity burdens, and adverse cytogenetic risks, we defined 3 distinct prognostic groups and compared outcomes after less-intensive vs intensive induction therapies in a multicenter retrospective cohort (n = 1292) treated at 6 institutions from 2008 to 2012 and a prospective cohort (n = 695) treated at 13 institutions from 2013 to 2017. Prospective study included impacts of Karnofsky performance status (KPS), quality of life (QOL), and physician perception of cure. In the retrospective cohort, recipients of less-intensive therapies were older and had more comorbidities, more adverse cytogenetics, and worse KPS. Less-intensive therapies were associated with higher risks of mortality in AML-CM scores of 4 to 6, 7 to 9, and ≥10. Results were independent of allogeneic transplantation and similar in those age 70 to 79 years. In the prospective cohort, the 2 groups were similar in baseline QOL, geriatric assessment, and patient outcome preferences. Higher mortality risks were seen after less-intensive therapies. However, in models adjusted for age, physician-assigned KPS, and chance of cure, mortality risks and QOL were similar. Less-intensive therapy recipients had shorter length of hospitalization (LOH). Our study questions the survival and QOL benefits (except LOH) of less-intensive therapies in patients with AML, including those age 70 to 79 years or with high comorbidity burdens. A randomized trial in older/medically infirm patients is required to better assess the value of less-intensive and intensive therapies or their combination. This trial was registered at www.clinicaltrials.gov as #NCT01929408.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 387-400 |
| Number of pages | 14 |
| Journal | Blood |
| Volume | 138 |
| Issue number | 5 |
| DOIs | |
| State | Published - Aug 5 2021 |
Funding
Research reported in this article was funded in part by a Patient-Centered Outcome Research Institute award (CE-1304-7451), a Research Scholar Grant from the American Cancer Society (RSG-13-084-01-CPHPS), and an American Society for Hematology Bridge Award. The authors are grateful to all research nurses and data coordinators for implementation of protocols. The authors also thank the administrative staff for their assistance with manuscript preparation. The authors are grateful to the many physicians, nurses, physician assistants, nurse practitioners, pharmacists, and support staff who cared for the patients and to the patients who allowed us to care for them and who participated in our ongoing clinical research. The authors also thank Helen Crawford, Tammy Schuler, Sophie Fluent, and Indira Ongarbaeva for their help in assembling data and preparing the manuscript. Research reported in this article was funded in part by a Patient-Centered Outcome Research Institute award (CE-1304-7451), a Research Scholar Grant from the American Cancer Society (RSG-13-084-01-CPHPS), and an American Society for Hematology Bridge Award. The funding organizations had absolutely no role in the design or conduct of the study; collection, management, analysis, or interpretation of the data; or preparation, review, or approval of the manuscript. The statements and findings in this article are solely the responsibility of the authors and do not necessarily represent the views of any funding organization, neither the Patient-Centered Outcomes Research Institute, its board of governors, or its methodology committee; the American Cancer Society; nor the America Society of Hematology.
ASJC Scopus subject areas
- Hematology
- Biochemistry
- Cell Biology
- Immunology