背景:急性白血病患者的生存率与年龄成反比。年轻AML患者的5年总生存率为50%,然而,如果年龄>70岁,则降低到<10%。造成影响的因素包括表现不佳,对诱导治疗的反应降低,治疗相关死亡率增加,不利的细胞遗传学和继发性白血病。
目的:报告观察了老年白血病患者的特点和转归。
方法:回顾性分析2015年7月1日至2021年6月30日收治的新诊断急性髓系白血病(AML)患者>65例。人口统计信息,分类,住院时间,服用血液制品,治疗,放电条件,缓解3个月和6个月,和收集的生存数据。
方法:学术医学中心。
方法:确定149例患者。AML[n=130],急性早幼粒细胞白血病(APL)[n=9],和未另作说明的急性白血病(AML-NOS)[n=10]。
方法:97例患者接受治疗。AML治疗:诱导治疗,柔红霉素和阿糖胞苷(脂质体),或低甲基化剂+/-维奈托克。APL处理:全反式维甲酸(ATRA)+/-三氧化二砷(ATO)。1例AML-NOS患者接受低甲基化。
结果:患者分为三组:<70[n=55],70到74[n=52],>75[n=60]。没有接受任何治疗的患者百分比随着年龄组的增加而增加(21.8%,32.7%,和41.7%)。住院时间,反思治疗,在年轻人口中最大(28天,17.6天,和15.3天)。6个月生存率51%年轻,中组42.3%,最年长组23.4%。治疗相关死亡率(TRM),包括过渡到临终关怀护理随着年龄的增加而增加(29%,34%和50%)。
结果:25/130例患者接受诱导化疗。19例患者<70。年轻队列的预期TRM为10.68%(1-41%),老年队列为10.1%(1-20%)。在年轻队列中观察到的TRM为10.5%,在老年队列中为50%。大多数年龄最大的AML患者接受低甲基化单一或联合治疗。所有AML中约有50%已出院。年轻人的6个月生存率为50%,中期为26.8%,最年长的为13.3%。确定了9名APL患者,其中5名在最老的队列中。仅3例(33.3%)存活6个月。AML-NOS患者在6个月时均未存活。
结论:尽管考虑到患者的年龄和表现状况,但老年人群的急性白血病仍然是一个挑战,预后较差。
BACKGROUND: Acute leukemia patients have a diminished survival inversely proportional to their age. 5-year overall survival in younger AML patients is 50%, however reduced to <10% if age >70. Factors contributing include poor performance status, decreased response to induction therapy, increased treatment related mortality, unfavorable cytogenetics and secondary leukemia.
OBJECTIVE: Report observed characteristics and outcomes of elderly leukemia patients.
METHODS: Retrospective chart
review of newly diagnosed acute myeloid leukemia (AML) patients >65 admitted from 7/1/2015 through 6/30/2021. Demographic information, classification, duration of hospital stay, blood products administered, treatment, discharge condition, 3 and 6 month remission, and survival data collected.
METHODS: Academic medical center.
METHODS: 149 patients identified. AML[n=130], acute promyelocytic leukemia (APL)[n=9], and acute leukemia not otherwise specified (AML-NOS)[n=10].
METHODS: 97 patients treated. AML treatment: Induction therapy,
daunorubicin and cytarabine (liposomal), or hypomethylating agent +/-venetoclax. APL treatment: all-trans retinoic acid (ATRA) +/- arsenic trioxide (ATO). One patient with AML-NOS received hypomethylator.
RESULTS: Patients separated into three groups: <70[n=55], 70 to 74[n=52], and >75[n=60]. Percent of patients who did not receive any therapy increased as age group increased (21.8%, 32.7%, and 41.7%). Length of hospital stay, reflective of treatment, was greatest in the younger population (28 days, 17.6 days, and 15.3 days). 6-month survival 51% younger, 42.3% middle and 23.4% for eldest cohort. Treatment related mortality (TRM) including transitioning to hospice care increased as age increased (29%, 34% and 50%).
RESULTS: 25/130 patients received induction chemotherapy. Nineteen patients were <70. The expected TRM for the younger cohort was 10.68% (1 - 41%) and 10.1% (1-20%) for elder cohort. The observed TRM was 10.5% in the younger cohort and 50% in the older cohort. Most of the eldest AML patients received a hypomethylating mono- or combination therapy. Nearly 50% of all AML were discharged home. The 6-month survival was 50% for younger, 26.8% for middle and 13.3% for eldest cohort. Nine APL patients were identified with 5 being in the eldest cohort. Only 3(33.3%) survived 6 months. None of the patients with AML-NOS were alive at 6 months.
CONCLUSIONS: Acute leukemia in the elderly population remains a challenge with poor outcomes despite considering patient\'s age and performance status.