Big Data on Real-World Applications. Chapter 2 : Real-World Treatment Patterns and Outcomes among Elderly Acute Myeloid Leukemia Patients in the United States

Abstract

Over half of patients diagnosed with acute myeloid leukemia (AML) are 65 years or older. Using the linked SEER-Medicare database, we conducted a retrospective cohort analysis to examine patient characteristics, treatment patterns, and survival among the elderly AML patients in routine clinical practice. Out of 29,857 patients with AML in the database, 8336 were eligible for inclusion in the study. The inclusion criteria included a diagnosis with first primary AML between January 1, 2000 and December 31, 2009, >66 years of age, and continuous enrollment in Medicare Parts A and B in the year before diagnosis. Forty percent (N = 3327) of the cohort received chemotherapy within 3 months after diagnosis. The multivariable overall survival analyses showed a lower risk of death among those receiving intensive and hypomethylating agent therapies compared with no therapy. Among the younger cohort, a significant lower mortality was also noted with receipt of allogeneic hematopoietic stem cell transplantation. Over the past decade, about 60% of the elderly AML patients remain untreated in routine clinical practice. Use of antileukemic therapy was associated with a significant survival benefit and provides further support that age alone should not deter the use of guideline-recommended therapies particularly because of the high disparities in outcomes between treatment receipt and palliative care in this elderly cohort.