Haematology, Royal Adelaide Hospital, Port Road, Adelaide, Australia.
Haematology, Royal Adelaide Hospital, Port Road, Adelaide, Australia; Precision Medicine Theme, South Australian Health and Medical Research Institute, Adelaide, Australia.
J Geriatr Oncol. 2021 Mar;12(2):243-249. doi: 10.1016/j.jgo.2020.07.002. Epub 2020 Jul 24.
The incidence of acute myeloid leukemia (AML) in older patients is increasing, but practice guidelines balancing quality-of-life, time outside of hospital and overall survival (OS) are not established.
We conducted a retrospective analysis comparing time outside hospital, OS and end-of-life care in AML patients ≥60 years treated with intensive chemotherapy (IC), hypomethylating agents (HMA) and best supportive care (BSC) in a tertiary hospital.
Of 201 patients diagnosed between 2005 and 2015, 54% received IC while 14% and 32% were treated with HMA and BSC respectively. Median OS was significantly higher in patients treated with IC and HMA compared with BSC (11.5 versus 16.2 versus 1.3 months; p < .0001). Median number of hospital admissions for the entire cohort was 3 (1-17) and patients spent <50% of their life after the diagnosis in the hospital setting. Compared to BSC, IC (HR 0.27, p < .0001) and HMA therapy (HR 0.16, p < .0001) were associated with the lower likelihood of spending at least 25% of survival time in hospital. Although 66% patients were referred to palliative care, the interval between referral to death was 24 (1-971) days and 46% patients died in the hospital.
Older patients with AML, irrespective of treatment, require intensive health care resources, are more likely to die in hospital and less likely to use hospice services. Older AML patients treated with disease modifying therapy survive longer than those receiving BSC, and spend >50% of survival time outside the hospital. These data are informative for counselling older patients with AML.
老年急性髓系白血病（AML）的发病率正在增加，但尚未制定平衡生活质量、院外时间和总生存（OS）的实践指南。
我们对一家三级医院中接受强化化疗（IC）、低甲基化药物（HMA）和最佳支持治疗（BSC）的 AML 患者的院外时间、OS 和临终关怀进行了回顾性分析。
在 2005 年至 2015 年间诊断的 201 名患者中，54%接受了 IC，14%和 32%分别接受了 HMA 和 BSC 治疗。与 BSC 相比，IC 和 HMA 治疗的患者 OS 中位数显著更高（11.5 个月对 16.2 个月对 1.3 个月；p<0.0001）。整个队列的中位住院次数为 3 次（1-17 次），患者在诊断后的生活中在医院环境中的时间不到 50%。与 BSC 相比，IC（HR 0.27，p<0.0001）和 HMA 治疗（HR 0.16，p<0.0001）与在医院度过至少 25%生存时间的可能性降低相关。尽管 66%的患者被转介至姑息治疗，但从转介到死亡的间隔为 24（1-971）天，46%的患者在医院死亡。
无论治疗如何，老年 AML 患者都需要密集的医疗保健资源，更有可能在医院死亡，并且不太可能使用临终关怀服务。接受疾病修正治疗的老年 AML 患者比接受 BSC 治疗的患者生存时间更长，且有超过 50%的生存时间在院外。这些数据为老年 AML 患者提供了信息支持。
