Abstract
We describe genetic and clinical characteristics of acute myeloid leukemia (AML) patients according to age from an academic population-based registry. Adult patients with newly diagnosed AML at 63 centers in Germany and Austria were followed within the AMLSG BiO registry (NCT01252485). Between January 1, 2012, and December 31, 2014, data of 3525 patients with AML (45% women) were collected. The median age was 65 years (range 18–94). The comparison of age-specific AML incidence rates with epidemiological cancer registries revealed excellent coverage in patients < 70 years old and good coverage up to the age of 80. The distribution according to the European LeukemiaNet (ELN) risk categorization from 2010 was 20% favorable, 31% intermediate-1, 28% intermediate-2, and 21% adverse. With increasing age, the relative but not the absolute prevalence of patients with ELN favorable and intermediate-1 risk (p < 0.001), with activating FLT3 mutations (p < 0.001), with ECOG performance status < 2 (p < 0.001), and with HCT-CI comorbidity index < 3 (p < 0.001) decreased. Regarding treatment, obesity and favorable risk were associated with an intensive treatment, whereas adverse risk, higher age, and comorbidity index > 0 were associated with non-intensive treatment or best supportive care. The AMLSG BiO registry provides reliable population-based distributions of genetic, clinical, and treatment characteristics according to age.
Highlights
Acute myeloid leukemia (AML) is the most frequent acute leukemia in adults with an incidence of 3 to 4 per 100,000 persons per year [1, 2]
The objectives of our study were to investigate epidemiological, genetic, and clinical characteristics of patients participating in the German-Austrian AML Study Group registry study (AMLSG BiO; ClinicalTrials.gov Identifier: NCT01252485) from 2012 to 2014, to compare them with selected epidemiological cancer registry data and to analyze distributions of genetic, clinical, and treatment characteristics according to age
Compared to other population-based cancer registries, the agespecific incidence rate of the AMLSG BiO registry is lower for persons of older age
Summary
Acute myeloid leukemia (AML) is the most frequent acute leukemia in adults with an incidence of 3 to 4 per 100,000 persons per year [1, 2]. Mutations in the genes such as nucleophosmin (NPM1), FMS-related tyrosine kinase 3 (FLT3), and CCAAT/ enhancer-binding protein alpha (CEBPA) in cytogenetically normal AML influence the prognosis of AML patients [12] and have entered clinical routine [11, 13]. Activating FLT3 mutations including internal tandem duplication (ITD) as well as tyrosine kinase domain (TKD) mutations and point mutations in exone 12 of NPM1 are reported as frequent mutations in AML in an average young trial population with reported incidences of 33 and 28%, respectively [8], whereas mutations in CEBPA are less frequent [12]. The multi-kinase inhibitor midostaurin has shown efficacy in a randomized phase III trial of patients with activating FLT3 mutations [14]
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