Chemotherapy for Acute Myeloid Leukemia Can Compensate Other Adverse Prognostic Factors in Elderly: A Retrospective Longitudinal Cohort Study in a Local Community, Japan

• Published in: Blood 2012-11, Vol.120 (21), p.3582-3582
• Main Authors: Imataki, Osamu, Ohnishi, Hiroaki, Kawachi, Yasunori, Ide, Makoto, Uemura, Makiko, Kawakami, Kimihiro, Matsuoka, Akihito, Waki, Masato, Takimoto, Hidetaka, Hoshijima, Yasuo, Fukumoto, Tetsuya, Matsumoto, Kensuke, Waki, Fusako, Taoka, Teruhisa, Matsunaga, Takuya
• Format: Article
• Language: English
• ISSN: 0006-4971; 1528-0020
• DOI: 10.1182/blood.V120.21.3582.3582

Abstract 3582 Japan is one of the prominent aging countries, in where incidence and mortality of malignancy in elderly is increasing which is recognized as a concerned national health care issue. Among various types of cancer, incidence and prevalence of elderly acute myeloid leukemia (AML) is increasing as well, and in the most cases those patients have concomitant diseases. Thus far, the treatment for AML in elderly has been generally realized to reduce the dose intensity due to impaired organ function and comorbidity. However, the utility of dose reduction in elderly AML has not been well understood. Thereby, we performed a retrospective population cohort study of AML in a local community in Japan in order to investigate practical risk factor based on general patient population including more than 65 to 75 years old. We reviewed medical charts and medical records of AML patients diagnosed at seven institutions in Kagawa prefecture between January 1, 2006 and December 31, 2010. We collected patients' characteristics, background, and clinical information including laboratory data, adverse events and outcome. Induction therapy regimen was practically decided by each treating physician based on available clinical data and local standards of care, but not on karyotype. We categorized chemotherapy regimens for non-APL patients into 3 groups; intensive chemotherapy, less-intensive chemotherapy, or best supportive care. A total of 213 patients (127 males and 86 females) were diagnosed with AML. With an average population during study periods in Kagawa, the incidence of AML is 4.26 per 100,000 per year. The male to female ratio was 1.48. The median age was 70 years (average 67, range 24∼95). There were 16 APL patients and 197 non-APL patients in this cohort. The 5-year overall survival (OS) rate was 21.1%. In patients who are likely to meet criteria usually applied in clinical studies (i.e., de novo AML with PS 0 to 2 and no renal dysfunction), the 5-year OS rate was 31.5%. Among 197 non-APL patients median age was 70 years (range 24∼95) consists of 119 males and 78 females. The chromosomal karyotype is known to be the strongest prognostic predictor, and each study group advocates the different classification. We classified our cohort according to 5 different karyotype classifications (NCCN, BSCH, MRC-AML10, SWOG and CALGB). On the whole, 4.4∼5.9% of the patients were classified as having favorable risk karyotypes, and 17.7∼29.1% of the patients had unfavorable