A real-world picture of patients with a new diagnosis of acute myeloid leukemia in Italy.

Abstract

6520 Background: Acute myeloid leukemia (AML) is a blood malignancy with poor prognosis. Antineoplastic strategies are still mostly restricted to fit patients. This analysis of administrative healthcare data identified and described newly AML diagnosed patients, their antineoplastic treatment and survival from the perspective of the Italian National Health Service (SSN). Methods: From the Fondazione ReS (Ricerca e Salute) database (~5 million inhabitants/year), among adults with primary/secondary in-hospital diagnosis of AML in 2018 (index date) and analysable look-back period until 2013, patients newly AML diagnosed were selected. They were characterized by age, sex and comorbidities (cardiometabolic, thyroid and cerebrovascular disorders, chronic kidney and liver disease, and inflammatory bowel diseases). During 1 year following index date, antineoplastic treatment and allogeneic stem cell transplantation (alloSCT) were assessed. Among patients undergoing antineoplastic therapy, those fit and unfit for intensive chemotherapy (ICHT) were categorized according to proxies based on the setting of chemotherapy administration (i.e., overnight hospitalization=fit, while daily hospitalization or local outpatient ambulatory=unfit). The 2-year overall survival (OS) of treated patients was assessed through a Kaplan Meyer analysis. Results: In 2018, 228 newly AML diagnosed patients (incidence: 5.7x100,000 adult inhabitants) were identified. Males were 56.6%. Mean age was 69±16 years, and 61% patients had ≥2 comorbidities. During 1 year following index date, 75% of newly AML diagnosed patients received antineoplastic treatment (males were 57%, mean age was 66±15 years, and 49% had ≥2 comorbidities). Of them, 19% underwent alloSCT (mean age was 50±14 years). On average, remaining untreated patients (57/228; 25%) were older (77±14 years) and affected by more comorbidities (79% with ≥2 comorbidities) than treated patients. At 2 years following index date, 97% of treated patients survived (vs 65% of untreated patients; p<0.01). Among treated patients, 51% (mean age was 64±15 years) were considered fit for ICHT, and 24% were considered unfit for ICHT (mean age was 71±15 years). At 2 years following index date, 38% of patients fit for ICHT survived (vs 29% of patients unfit for ICHT; p<0.01). Conclusions: This real-word analysis suggests that patients receiving antineoplastic treatments, regardless of a following alloSCT, were younger and affected by less comorbidities than untreated patients. Also, older patients are likely to be excluded from the ICHT option, as recommended by most of guidelines. However, these findings suggest that being treated with chemotherapy and/or alloSCT can increase survival probabilities.