Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), University of Cologne, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany.
Mildred Scheel School of Oncology Aachen Bonn Cologne Düsseldorf (MSSO ABCD), Faculty of Medicine and University Hospital of Cologne, Cologne, Germany.
Hematol Oncol. 2024 Sep;42(5):e3300. doi: 10.1002/hon.3300.
The overall prognosis of older patients with acute myeloid leukemia (AML) is dismal. Only a small subgroup experiences long-term survival. The discrimination between patients who are candidates for potentially curative approaches and those who are not is crucial since - in addition to differences in terms of AML-directed treatment - different policies concerning intensive care unit (ICU) admission and involvement of specialized palliative care (SPC) seem obvious. To shed more light on characteristics, outcomes and health care utilization of older individuals with AML, we conducted an analysis comprising 107 consecutive patients with newly diagnosed AML aged ≥70 years treated at an academic tertiary care center in Germany between 1 January 2015, and 31 December 2020. Median age was 75 years (range: 70-87 years); 45% of patients were female. The proportion of patients receiving intensive induction chemotherapy was 35%, 55% had low-intensity treatment and 10% did not receive AML-directed treatment or follow-up ended before treatment initiation. At least one ICU admission was documented for 47% of patients; SPC was involved in 43% of cases. Median follow-up was 199 days. The median overall survival (OS) was 2.5 months; the 1-year OS rate was 16%. Among patients who died during observation, the median proportion of time spent in the hospital between AML diagnosis and death was 56%. The most common places of death were normal wards (31%) and the ICU (28%). Patients less frequently died in a palliative care unit (14%) or at home (12%). In summary, results of the present analysis confirm the unfavorable prognosis of older patients with AML despite intensive health care utilization. Future efforts in this patient group should aim at optimizing the balance between appropriate AML-directed treatment on the one hand and health care utilization including ICU stays on the other hand.
老年急性髓系白血病（AML）患者的总体预后较差。只有一小部分患者能够长期生存。区分有潜在治愈可能的患者和没有治愈可能的患者是至关重要的，因为除了 AML 靶向治疗方面的差异外，对于重症监护病房（ICU）入院和专门姑息治疗（SPC）的参与，不同的政策似乎也是显而易见的。为了更清楚地了解老年 AML 患者的特征、结局和医疗保健利用情况，我们对 2015 年 1 月 1 日至 2020 年 12 月 31 日期间在德国一家学术性三级护理中心接受治疗的 107 例新诊断为 AML 且年龄≥70 岁的连续患者进行了一项分析。中位年龄为 75 岁（范围：70-87 岁）；45%的患者为女性。接受强化诱导化疗的患者比例为 35%，55%接受低强度治疗，10%未接受 AML 靶向治疗或随访在治疗开始前结束。至少有 47%的患者记录了 ICU 入院；43%的病例涉及 SPC。中位随访时间为 199 天。中位总生存期（OS）为 2.5 个月；1 年 OS 率为 16%。在观察期间死亡的患者中，AML 诊断至死亡期间在医院的中位时间比例为 56%。最常见的死亡地点是普通病房（31%）和 ICU（28%）。患者较少在姑息治疗病房（14%）或家中（12%）死亡。总之，本分析的结果证实，尽管进行了密集的医疗保健利用，老年 AML 患者的预后仍不佳。未来应努力在这一患者群体中优化适当的 AML 靶向治疗与包括 ICU 入住在内的医疗保健利用之间的平衡。
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