Allogeneic transplant leads to markedly improved survival in older patients with AML.

Abstract

7048 Background: AML is a disease of the elderly, and outcomes with standard treatment are dismal. Allogeneic transplant is the only curative therapy for most patients with AML. Recent work has shown age is not a factor in transplant outcomes, and should not be a limiting factor for transplant. The treatment pathway for older patients with AML should take into account their disease risk, comorbidities, and treatments with a proven survival advantage. We investigated our institutional experience to help guide the establishment of optimal pathways for patients. Methods: We conducted a retrospective analysis of 118 patients over age 65 with AML treated at our institution between 2010-2015. Patients receiving therapy (n = 90) were categorized into two groups: intensive induction therapy (7+3 based) or induction therapy with a hypomethylating agent. The groups were well matched in regard to comorbidities. Results: In poor risk patients, complete remission (CR) was achieved in 42% (n = 30/71). Select patients up to age 75 proceeded to allogeneic transplant if they achieved CR. Survival in CR1 was higher in the transplant (n = 22, median 719 days, 95% CI: 366-1071 days), than in the non-transplant group (n = 8, median 257 days, 95% CI: 92-421 days, p-value < .001). In analyzing all risk groups, overall survival was superior in transplant (median 1188 days) versus non-transplant recipients (median 185 days) (see 1, 2, and 3 year survival in table). No difference in median survival occurred based on age at induction (older than 70: n = 9, younger than 70: n = 16, p-value = 0.316). There was no difference in median survival based on chemotherapy regimen without transplant: intensive induction (n = 24, survival 250 days, p-value 0.179) compared to hypomethylating agents (n = 22, survival 139 days). Conclusions: We confirm that transplant can be safely performed in patients over 70 years of age, and highlight the survival advantage of transplant to chemotherapy alone. Additionally, our data found no survival benefit of hypomethylating agents in elderly patients with poor risk AML.[Table: see text]