Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Department of Medicine, Baylor College of Medicine, Houston, Texas, USA.
Am J Hematol. 2023 Sep;98(9):1383-1393. doi: 10.1002/ajh.26997. Epub 2023 Jun 19.
Outcomes in older patients with acute myeloid leukemia (AML) have historically been poor. Given advances in low-intensity therapy (LIT) and stem cell transplantation (SCT), we performed a retrospective single-center study to evaluate the contemporary outcomes of this population. We reviewed all patients ≥60 years with newly diagnosed AML between 2012 and 2021 and analyzed treatment and SCT-related trends and outcomes. We identified 1073 patients with a median age of 71 years. Adverse clinical and cytomolecular findings were frequent within this cohort. In total, 16% of patients were treated with intensive chemotherapy, 51% with LIT alone, and 32% with LIT plus venetoclax. The composite complete remission rate with LIT plus venetoclax was 72%, which was higher than with LIT alone (48%, p < .0001) and comparable to intensive chemotherapy (74%, p = .6). The median overall survival (OS) with intensive chemotherapy, LIT, and LIT plus venetoclax was 20.1, 8.9, and 12.1 months, respectively. 18% of patients received SCT. SCT rates were 37%, 10%, and 22% in patients treated with intensive chemotherapy, LIT, and LIT plus venetoclax, respectively. The 2-year OS, relapse-free survival (RFS), cumulative incidence (CI) of relapse, and CI of treatment-related mortality with frontline SCT (n = 139) were 59%, 52%, 27%, and 22%, respectively. By landmark analysis, patients undergoing frontline SCT had superior OS (median 39.6 vs. 21.4 months, p < .0001) and RFS (30.9 vs. 12.1 months, p < .0001) compared with responding patients who did not. Outcomes in older patients with AML are improving with more effective LIT. Measures should be pursued to increase access to SCT in older patients.
老年急性髓系白血病（AML）患者的预后历来较差。鉴于低强度治疗（LIT）和干细胞移植（SCT）的进展，我们进行了一项回顾性单中心研究，以评估该人群的当代结局。我们回顾了 2012 年至 2021 年间所有新诊断为 AML 的年龄≥60 岁的患者，并分析了治疗和 SCT 相关的趋势和结局。我们共确定了 1073 例中位年龄为 71 岁的患者。在该队列中，不良的临床和细胞分子发现很常见。总的来说，16%的患者接受强化化疗，51%的患者接受单独的 LIT，32%的患者接受 LIT 联合 venetoclax。LIT 联合 venetoclax 的完全缓解率为 72%，高于单独 LIT（48%，p<0.0001），与强化化疗相当（74%，p=0.6）。强化化疗、LIT 和 LIT 联合 venetoclax 的中位总生存期（OS）分别为 20.1、8.9 和 12.1 个月。18%的患者接受了 SCT。接受强化化疗、LIT 和 LIT 联合 venetoclax 的患者分别有 37%、10%和 22%接受了 SCT。接受一线 SCT（n=139）的患者 2 年 OS、无复发生存（RFS）、复发累积发生率（CI）和治疗相关死亡率的 CI 分别为 59%、52%、27%和 22%。通过里程碑分析，接受一线 SCT 的患者 OS（中位 39.6 与 21.4 个月，p<0.0001）和 RFS（30.9 与 12.1 个月，p<0.0001）均优于未接受 SCT 的缓解患者。AML 老年患者的预后随着更有效的 LIT 而改善。应采取措施增加老年患者接受 SCT 的机会。
