AML-021 A Retrospective Study of Clinical Characteristics and Outcomes of Elderly Acute Myeloid Leukemia (AML) Patients at Oncology Center Mansoura University (OCMU)

Abstract

Acute myeloid leukemia incidence increases progressively with advancing age and represents a therapeutic challenge. The tools used for comprehensive geriatric assessment (CGA) in elderly AML are not uniform. Outcome of treatment for patients of advanced age is often compromised by comorbidities and an enhanced susceptibility to toxicities from therapy. This study intended to determine the demographic data, clinical characteristics, and the treatment and outcomes in de novo elderly AML patients. This is a retrospective single-center study of 226 patients; (≥ 60 years) with a diagnosis of AML identified from the Database (2010- 2020) and were followed till the end of 2021. It was carried out at Oncology Center Mansoura University (OCMU). The median age were 67.12±5.65 years, M/F: 128/98. 196 (86.7%) showed ECOG ≥2 performance status at diagnosis. Eighty-three patients received standard induction treatment (7+3), 83 received reduced-intensity treatment (LDAC, azacytidine) and 60 patients were unfit for treatment. At the end of the review of the study, 65 were alive. Comorbidities were assessed using Charlson Comorbidity Index (CCI) and Cumulative Illness Rating Scale-Geriatric (CIRS-G) scores. Treatment-associated adverse events were evaluated by WHO toxicity grades. The Cox regression model was used to examine predictors affecting overall survival (OS). Hypertension (37%), pulmonary infections (24.7%) and diabetes mellitus (20.8%) were the most common comorbidities. 207 patients were available for response assessment: 35(16.9%) achieved CR, 57 (27.5%) achieved PR. Grade 3-4 hematological toxicities were: anemia (62.7%), granulocytopenia (63.85%) and thrombocytopenia (82%). The median OS was 2 (95%CI 1.66-2.34) months. PS ≥2, CCI >4 and high CIRS-G scores were shown to be risk factors of dismal OS in older AML patients (P<0.001, 0.021 and 0.001, respectively). Patients with CR had better median OS (21 months (95%CI 7.55-34.45, P<0.001) and DFS (12 months (95%CI 6.74-17.26, P<0.001). Early mortality in elderly AML patients is common, especially in institutions with low resources due to lack of novel therapies and clinical trials. Geriatric assessment tools should be updated for detection and prediction of prognostic factors and plan management strategies according to disease risk stratification.