Abstract
Although approximately 50% of patients with acute myeloid leukemia (AML) are diagnosed over the age of 60 years, there is currently no established consensus on the treatment of elderly AML patients. Herein, we aimed to explore the incidence, medical expenditure, treatment, and outcomes of elderly AML patients in Korea by analyzing a nationwide cohort. We employed the Korean National Health Insurance Service-Senior cohort, which represents 10% of a random selection from a total of 5.5 million subjects aged 60 years or older. AML patients were identified according to the main diagnostic criteria of acute leukemia. Treatment for AML was divided into high- (high-dose cytarabine ± idarubicin) and low- (low-dose cytarabine or hypomethylating agents) intensity chemo-therapy and classified according to the chemotherapeutics protocol. We analyzed the survival outcomes and medical expenditures. Among 558,147 elderly patients, 471 were diagnosed with AML, and 195 (41.4%) were treated with chemotherapy. The median age was 65 years, and the median overall survival (OS) was 4.93 months (95% confidence interval, 4.47–5.43). Median OS was longer in patients undergoing chemotherapy than those in the best supportive care group (6.28 vs. 3.45 months, p < 0.001), and the difference was prominent in patients aged < 70 years. Twenty-eight (5.9%) patients received high-intensity chemotherapy, while 146 (31.0%) received low-intensity chemotherapy. The difference in median OS according to dose intensity was 4.6 months, which was longer in the high-intensity chemotherapy group (9.8 vs. 5.2 months in low-intensity group); however, the difference was not statistically significant. Patients who received high-intensity chemotherapy recorded longer hospital stays and incurred greater expenses on initial hospitalization. Elderly AML patients in Korea exhibited clinical benefits from chemotherapy. Although patients should be carefully selected for intensive treatment, chemotherapy, including low-intensity treatment, can be considered in elderly patients. Moreover, prospective studies on new agents or new treatment strategies are needed.
Highlights
A total of 195 patients treated with chemotherapy were administered cytotoxic and hypomethylating agents
51% of treated patients were in their 60s, and the median age was 65 years
Our findings confirmed the benefit of treatment in contrast to palliative therapy in the elderly Acute myeloid leukemia (AML) patient population and strongly indicated that chemotherapy, including a low-intensity regimen, should be considered in the majority of older patients
Summary
Acute leukemia is one of the most commonly diagnosed cancers, accounting for about. 3.5% of all cancer incidences and 4% of total cancer-derived mortalities in the United States, and is estimated to bear the 11th highest incidence among all cancers worldwide. The leukemia incidence has stayed relatively stable over the years, but regional variations have been reported in different geological areas owing to the differences in ethnicity, environmental factors, and lifestyles. Acute myeloid leukemia (AML) is the most common myeloid malignancy, accounting for 33.3% of all myeloid diseases in Korea [1]. The highest incidence of AML is observed in patients in their 70s, and approximately 50% of AML
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