Temporal patterns and predictors of receiving no active treatment among older patients with acute myeloid leukemia in the United States: A population-level analysis

Abstract

Background: The majority of patients with acute myeloid leukemia (AML) are aged >65 years at the time of diagnosis and are not actively treated. The objective of the current study was to determine the prevalence, temporal trends, and factors associated with no active treatment (NAT) among older patients with AML in the United States.

Methods: A retrospective analysis was performed of Surveillance, Epidemiology, and End Results (SEER)-Medicare data from 14,089 patients with AML residing in the United States who were diagnosed with AML at age ≥66 years during 2001 through 2013. NAT was defined as not receiving any chemotherapy, including hypomethylating agents. Multivariable logistic regression models were used to analyze sociodemographic, clinical, and provider characteristics associated with NAT.

Results: The percentage of patients with NAT decreased over time from 59.7% among patients diagnosed in 2001 to 42.8% among those diagnosed in 2013. The median overall survival for the entire cohort was 82 days from the time of diagnosis. Patients treated with NAT had worse survival compared with those receiving active treatment. Variables found to be associated with higher odds of NAT included older age, certain sociodemographic characteristics (household income within the lowest quartile, residence outside the Northeast region of the United States, and being unmarried), and clinical factors (≥3 comorbidities, the presence of mental disorders, recent hospitalization, and disability).

Conclusions: Greater than one-half of older patients with AML residing in the United States do not receive any active leukemia-directed therapy despite the availability of lower intensity therapies such as hypomethylating agents. Lack of active therapy receipt is associated with inferior survival. Identifying predictors of NAT might improve the quality of care and survival in this patient population, especially as novel therapeutic options with lower toxicity are becoming available.

Keywords: AML; Epidemiology; Surveillance; acute myeloid leukemia; and End Results (SEER)-Medicare; elderly; no active treatment; outcome.

Figure 1:. Temporal trends of treatment patterns in elderly patients with AML

(A) illustrates the temporal trends of treatment patterns during the study period. The proportion of patients with NAT decreased from 59.7% (635 out of 1,063 patients) of those diagnosed in 2001 to 42.8% (523 out of 1,220 patients) of those diagnosed in 2013. Among the 6,664 patients who received active treatment, 84.9% received their first therapy course within 60 days after diagnosis. The proportion of patients whose treatment was initiated within 60 days increased over time, from 78.3% among those diagnosed in 2001 to 90.5% among those diagnosed in 2013. (B) overall females were more likely than man to receive NAT (55.6% of female patients vs. 50.3% of male patients). This overall trend was also present in all age subgroups except for the age group 66–69 years in which men (31.9%) were more likely than women to receive NAT (27.5%).