Abstract
Practice patterns and clinical outcomes of therapy-related acute myeloid leukemia (TAML) in the US
Journal of clinical oncology, Vol.35(15_suppl), pp.e18139-e18139
05/20/2017
DOI: 10.1200/JCO.2017.35.15_suppl.e18139
Abstract
e18139
Background: tAML, compared to de novo AML, has higher adverse features and a shorter overall survival (OS). The use of chemotherapy and hematopoietic cell transplant (HCT), and OS of tAML outside of clinical trials has not been studied well. Current study was designed to identify the treatment patterns and OS of tAML based on a national database. Methods: A total of 1,611 cases of tAML were identified between 2001-2011 using the National Cancer Database (NCDB). Data on age, race, gender, income, insurance and educational status, Charlson comorbidity index (CCI), receipt of chemotherapy and HCT were abstracted. Log-rank test was used to test equality of survivor function among the variables. Factors that attained statistical significance during bivariate analysis were factored into multivariate analysis using Cox Regression model. Results: Median age at diagnosis was 63 years (range 18-90), with 54% < 65 years, 59% females and 80% Caucasians. 67% underwent chemotherapy (20% single agent, 45% multiple agents and 2% unknown). 19% received HCT. Median OS was 6.7 months (m) with 1-year OS of 33%. Median OS was lower among patients ≥65 versus < 65 years (4.1 vs. 9.5 m; p < 0.001), those with higher comorbidity burden (7.8 m for CCI of 0, 6.0 m for CCI of 1, and 3.8 m for CCI of 2; p < 0.001), and diagnosed before versus during/after 2008 (5.6 vs. 7.7 m, p = 0.05). Median OS was higher among patients who received chemotherapy (8.4 vs. 3.7 m; p < 0.001) and HCT (22.6 vs. 4.9 m, p < 0.001), as compared to those who did not. Cox regression model showed the predictors of OS to be: receipt of HCT (hazard ratio, HR 0.36); use of multiagent chemotherapy (HR 0.80); age≥65 years (HR 1.25), higher comorbidities (HR of 1.21 for CCI of 1, and 1.45 for CCI of 2) and diagnosis on or after 2008 (HR of 0.81). Conclusions: Over half of patients with tAML are younger adults ( < 65 years), however, the receipt of chemotherapy and HCT is relatively low. OS is poor in general but improves with the use of multiagent chemotherapy and HCT. OS is worse in older patients and those with comorbidities. Given a dismal prognosis, older patients may be managed by leukemia team with expertise in geriatric oncology and should be encouraged to participate in clinical trials of novel therapies.
Details
- Title: Subtitle
- Practice patterns and clinical outcomes of therapy-related acute myeloid leukemia (TAML) in the US
- Creators
- Manisha Pant - Staten Island University HospitalSmith Giri - Yale UniversityPrajwal Dhakal - Michigan State UniversityVijaya Raj Bhatt - University of Nebraska Medical Center
- Resource Type
- Abstract
- Publication Details
- Journal of clinical oncology, Vol.35(15_suppl), pp.e18139-e18139
- DOI
- 10.1200/JCO.2017.35.15_suppl.e18139
- ISSN
- 0732-183X
- eISSN
- 1527-7755
- Language
- English
- Date published
- 05/20/2017
- Academic Unit
- Hematology, Oncology, and Blood & Marrow Transplantation; Internal Medicine
- Record Identifier
- 9984361573602771
Metrics
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