Treatment patterns and comparative analysis of non-intensive regimens in elderly acute myeloid leukemia patients—a real-world experience from India

Abstract

Elderly patients with acute myeloid leukemia have a poor prognosis. Data from developing countries is sparse in the literature. In this retrospective study, 402 patients aged ≥\u200960\xa0years, diagnosed between Jan 2013 and Dec 2017, were analyzed for treatment patterns and survival. Median age of the whole cohort was 68\xa0years (range 61–84). A total of 213 patients (53.3%) refused care; 188 patients (46.7%) received either BSC, LDAC, or HMA. Survival (in months) was 3.9, 6.4, and 1.2 with LDAC, HMA, and BSC, respectively. One-year survival was 17.2% and 6% with HMA and LDAC, respectively (P\u2009=\u20090.02). Overall response rate (ORR) did not differ between HMA and LDAC group (p\u2009=\u20090.12). HMA cohort had higher complete responses (20.6% vs 7.4%, p\u2009=\u20090.02), stable disease (32.7% vs 13.5%, p\u2009=\u20090.02), and transfusion independence (TI) (46.5% vs 22.2%, p\u2009=\u20090.01). Survival did not differ between the groups if the patients achieved ORR (12.3 vs 9.8 p\u2009=\u20090.2) or TI (11.6 vs 6.4 p\u2009=\u20090.2). Stable disease with HMA led to longer survival (8.1 vs 5.3 p\u2009=\u20090.01). HMAs were more effective than LDAC irrespective of cytogenetic risk category and blasts, of note HMAs improved survival of poor risk patients (5.6 vs 2.9 p\u2009=\u20090.004). HMA treatment (HR\u2009=\u20090.48; 95% 0.29–0.79, p\u2009=\u20090.004) and transfusion independence (HR\u2009=\u20090.2; 95% 0.1–0.3, p\u2009=\u20090.0001) predicted survival in multivariate analysis. Neutropenia and febrile neutropenia were frequent in HMA. Thrombocytopenia was the common adverse event with LDAC. Novel and cost-effective drugs are essential to improve the prognosis of these patients.