Department of Internal Medicine, Inha University Hospital, Incheon 22332, Korea.
Department of Biostatistics, Korea University College of Medicine, Seoul 02841, Korea.
Int J Environ Res Public Health. 2022 Feb 17;19(4):2317. doi: 10.3390/ijerph19042317.
Although approximately 50% of patients with acute myeloid leukemia (AML) are diagnosed over the age of 60 years, there is currently no established consensus on the treatment of elderly AML patients. Herein, we aimed to explore the incidence, medical expenditure, treatment, and outcomes of elderly AML patients in Korea by analyzing a nationwide cohort. We employed the Korean National Health Insurance Service-Senior cohort, which represents 10% of a random selection from a total of 5.5 million subjects aged 60 years or older. AML patients were identified according to the main diagnostic criteria of acute leukemia. Treatment for AML was divided into high- (high-dose cytarabine ± idarubicin) and low- (low-dose cytarabine or hypomethylating agents) intensity chemo-therapy and classified according to the chemotherapeutics protocol. We analyzed the survival outcomes and medical expenditures. Among 558,147 elderly patients, 471 were diagnosed with AML, and 195 (41.4%) were treated with chemotherapy. The median age was 65 years, and the median overall survival (OS) was 4.93 months (95% confidence interval, 4.47-5.43). Median OS was longer in patients undergoing chemotherapy than those in the best supportive care group (6.28 vs. 3.45 months, < 0.001), and the difference was prominent in patients aged < 70 years. Twenty-eight (5.9%) patients received high-intensity chemotherapy, while 146 (31.0%) received low-intensity chemotherapy. The difference in median OS according to dose intensity was 4.6 months, which was longer in the high-intensity chemotherapy group (9.8 vs. 5.2 months in low-intensity group); however, the difference was not statistically significant. Patients who received high-intensity chemotherapy recorded longer hospital stays and incurred greater expenses on initial hospitalization. Elderly AML patients in Korea exhibited clinical benefits from chemotherapy. Although patients should be carefully selected for intensive treatment, chemotherapy, including low-intensity treatment, can be considered in elderly patients. Moreover, prospective studies on new agents or new treatment strategies are needed.
虽然约有 50%的急性髓系白血病 (AML) 患者在 60 岁以上被诊断出来，但目前对于老年 AML 患者的治疗尚无明确共识。在此，我们通过分析一项全国性队列研究，旨在探讨韩国老年 AML 患者的发病率、医疗支出、治疗方法和结局。我们使用韩国国家健康保险服务-老年队列，该队列代表了总共 550 万 60 岁或以上的随机选择的 10%。AML 患者根据急性白血病的主要诊断标准确定。AML 的治疗分为高强度（高剂量阿糖胞苷±伊达比星）和低强度（低剂量阿糖胞苷或低甲基化剂）化疗，并根据化疗方案进行分类。我们分析了生存结果和医疗支出。在 558,147 名老年患者中，有 471 名被诊断为 AML，其中 195 名（41.4%）接受了化疗。中位年龄为 65 岁，中位总生存期（OS）为 4.93 个月（95%置信区间，4.47-5.43）。与最佳支持治疗组相比，接受化疗的患者中位 OS 更长（6.28 与 3.45 个月，<0.001），并且在年龄<70 岁的患者中差异更为显著。28 名（5.9%）患者接受高强度化疗，而 146 名（31.0%）患者接受低强度化疗。根据剂量强度的中位 OS 差异为 4.6 个月，高强度化疗组更长（9.8 与低强度组 5.2 个月）；然而，差异无统计学意义。接受高强度化疗的患者住院时间更长，初始住院费用更高。韩国老年 AML 患者从化疗中获益。虽然应仔细选择患者进行强化治疗，但可考虑对老年患者进行化疗，包括低强度治疗。此外，需要进行新药物或新治疗策略的前瞻性研究。
