A retrospective, real-world population-based analysis of treatment patterns and outcomes in adult patients with relapsed/refractory acute myeloid leukemia in Alberta, Canada.

e18505 Background: In order to describe the impact of future targeted therapies on treatment outcomes of patients (pts) with relapsed and/or refractory (RR) acute myeloid leukemia (AML), a better understanding of the clinical management pathway in these pts is needed. We therefore evaluated the treatment patterns and associated outcomes in a real-world cohort of pts with RR-AML using a population-based cancer registry and patient medical records. Methods: Pts newly diagnosed wih AML between January 2013 and December 2016, aged ≥ 18 years were identified from the provincial-wide Alberta Cancer Registry (ACR). Data for pts who met the criteria for RR-AML were assessed by hematologists and were extracted from medical records. RR-AML pts were then categorized as: receiving intensive therapy (IT); receiving non-intensive therapy (NIT); or treated with best-supportive care (BSC) following a diagnosis of RR-AML. Results: 572 AML pts were identified from the ACR, of which 199 met criteria for RR-AML and were included in the analysis (124 males, 75 females; median age at diagnosis of RR-AML 66.8 years; median follow-up 4.7 months). In this RR-AML cohort, 26 (13%) pts received ≥ 2 lines of prior therapy. Unadjusted median overall survival (mOS) was 5.3 months, with a 12-month overall survival rate of 29.6% (95% CI 29.0–30.3%) from the time of RR. Following RR, 46 (23%) pts received IT, 65 (33%) pts were treated with NIT, and 88 (44%) pts received BSC, with unadjusted mOS of 13.8, 9.4, and 2.1 months, respectively ( P < 0.001). When stratified by European LeukemiaNet risk classification at diagnosis, unadjusted mOS was 12.4, 4.7, and 4.0 months for favorable risk, intermediate risk, and adverse risk groups, respectively ( P < 0.01). Conclusions: This retrospective, real-world study in Alberta Canada confirms the poor prognosis reported to date in the RR-AML population. Notably, a large proportion of pts received BSC which was associated with dismal survival outcomes. These data also highlight that effective and tolerable alternatives to current treatment options are urgently needed.

Download Full-text

Longer Distance to a Specialized Treatment Center Does Not Adversely Affect Access to Treatment or Outcome in Acute Myeloid Leukemia: A National Population-Based Cohort Study

Blood ◽

10.1182/blood-2018-99-110922 ◽

2018 ◽

Vol 132 (Supplement 1) ◽

pp. 613-613 ◽

Cited By ~ 1

Author(s):

Michael Buch Tostesen ◽

Jan M. Norgaard ◽

Mette Nørgaard ◽

Bruno C. Medeiros ◽

Claus Werenberg Marcher ◽

...

Keyword(s):

Overall Survival ◽

Acute Myeloid Leukemia ◽

Myeloid Leukemia ◽

Intensive Therapy ◽

Population Based ◽

Treatment Center ◽

Intensive Chemotherapy ◽

Specialized Treatment ◽

Individual Level ◽

Acute Myeloid

Abstract BACKGROUND Treatment of acute myeloid leukemia (AML) is widely centralized at specialized centers. Longer distances to a specialized treatment facility may affect patients' access to curative-intended treatment and ultimately survival. Few studies have focused on the potential distance decay association in hematological cancers and limitations include small sample size and lack of individual-level socioeconomic, clinical, and treatment information. AIM We designed a large national population-based cohort study of all AML patients diagnosed in Denmark between 2000-2014 (followup ending 2017) to investigate the effect of distance on treatment intensity and outcome considering individual-level clinical and socioeconomic factors. METHODS Demographics, clinical, and outcome data were obtained from the Danish National Acute Leukemia Registry (DNLR). Socioeconomic information was retrieved from registries at Statistics Denmark (Figure 1). Distance to specialized treatment centres was calculated using shortest route (Google Maps) from city center of habitation and categorized into groups. We investigated effects of distance to nearest specialized treatment center on chance of receiving intensive chemotherapy using logistic regression analysis (odds ratios; ORs). In intensive therapy patients, we calculated chance of complete remission (CR [ORs]) and in allogeneic transplantation (HSCT) candidates; we estimated chance of HSCT (ORs). Overall survival was calculated for all patients and in intensive therapy patients only using cox regression (Hazard Ratios; HRs). All results were adjusted for sex, age, and individual-level socioeconomic (ethnicity, income, education, and occupation) and disease-related factors (WBC, secondary or therapy-related AML, cytogenetics, performance status, and comorbidity). Results were given crude and adjusted with 95% confidence intervals (CI), and stratified by age (<65 years; ≥65 years). RESULTS Of 2992 patients (median age 68.5 years), 53% received intensive chemotherapy, and 71% (n=1045) achieved a CR. The median distance to a specialized treatment center was 40 km (interquartile range 10-77 km). Patients living furthest from a specialized center had lower income and lower educational level. No negative impact of distance to specialized treatment center was seen on chance of receiving intensive therapy (adjusted ORs: <10 km 1.0, 10-25 km 1.10 (CI=0.69-1.73), 25-50 km 1.10 (CI=0.73-1.66), 50-100 km 1.33 (CI=0.90-1.97), and >100 km aOR 1.40 (CI=0.90-2.16)). In intensive therapy patients (n=1588), distance to specialized treatment center did not affect time from diagnosis to chemotherapy initiation or chance of achieving a CR. In HSCT candidates (866 patients ≤70 years with non-favorable cytogenetics achieving CR), longer distance to transplant center was not negatively associated with chance of HSCT (adjusted ORs: distance<50 km 1.0, 50-200 km 1,27 (CI=0.56-2.90), and >200 km 0.77 (CI=0.34-1.74)). The median follow up time was 514.5 days. Figure 2 shows crude survival by distance to specialized treatment center overall and in selected subgroups. Overall survival was not affected by distance to specialized treatment center (adjusted HRs: distance <10 km 1.0, 10-25 km 0.98 (CI=0.84-1.16), 25-50 km 1.01 (CI=0.88-1.18), 50-100 km 1.01 (CI=0.88-1.16), and >100 km 0.99 (CI=0.85-1.16)). Similar results were found in intensive patients only. Stratifying by age or analyzing distance as a continuous variable did not change the overall interpretation of results. CONCLUSION In a population-based national setting, distance to specialized treatment facilities offering remission-induction chemotherapy and HSCT, does not affect access to care, treatment outcome, or survival in AML patients. These findings support that the current centralization of specialized treatment does not negatively affects AML outcomes in a universal health-care system. Disclosures No relevant conflicts of interest to declare.

Download Full-text

Treatment patterns in patients with acute myeloid leukemia in the United States: a cross-sectional, real-world survey

Current Medical Research and Opinion ◽

10.1080/03007995.2019.1578152 ◽

2019 ◽

Vol 35 (5) ◽

pp. 927-935 ◽

Cited By ~ 3

Author(s):

Bruno C. Medeiros ◽

Bhavik J. Pandya ◽

Anna Hadfield ◽

James Pike ◽

Samuel Wilson ◽

...

Keyword(s):

United States ◽

Acute Myeloid Leukemia ◽

Real World ◽

Myeloid Leukemia ◽

The United States ◽

Treatment Patterns ◽

Cross Sectional ◽

World Survey ◽

Acute Myeloid

Download Full-text

Treatment patterns and costs associated with acute myeloid leukemia in the elderly: A population-based analysis

Journal of Clinical Oncology ◽

10.1200/jco.2004.22.90140.6613 ◽

2004 ◽

Vol 22 (14_suppl) ◽

pp. 6613-6613

Author(s):

J. Menzin ◽

K. Lang ◽

C. Earle ◽

T. Foster ◽

D. Dixon ◽

...

Keyword(s):

Acute Myeloid Leukemia ◽

Myeloid Leukemia ◽

The Elderly ◽

Population Based ◽

Treatment Patterns ◽

Acute Myeloid

Download Full-text

PS1043 OUTCOMES OF PATIENTS WITH RELAPSED OR REFRACTORY ACUTE MYELOID LEUKEMIA: A POPULATION-BASED REAL-WORLD STUDY

HemaSphere ◽

10.1097/01.hs9.0000562468.89369.69 ◽

2019 ◽

Vol 3 (S1) ◽

pp. 471-472

Author(s):

L. Saini ◽

M.N. Geddes ◽

F.F. Liu ◽

D. Yusuf ◽

K. Schwann ◽

...

Keyword(s):

Acute Myeloid Leukemia ◽

Real World ◽

Myeloid Leukemia ◽

Population Based ◽

Refractory Acute Myeloid Leukemia ◽

Acute Myeloid

Download Full-text

Faculty Opinions recommendation of Acute myeloid leukemia in the real world: why population-based registries are needed.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.14173956.15678056 ◽

2012 ◽

Author(s):

Parameswaran Hari ◽

Robert Frank Cornell

Keyword(s):

Acute Myeloid Leukemia ◽

Real World ◽

Myeloid Leukemia ◽

Population Based ◽

The Real ◽

Acute Myeloid

Download Full-text

Long-term trends in the clinical outcomes of patients with acute myeloid leukemia: a population-based real-world data analysis using the Osaka Cancer Registry

Annals of Hematology ◽

10.1007/s00277-021-04631-8 ◽

2021 ◽

Author(s):

Shigeo Fuji ◽

Shuhei Kida ◽

Kayo Nakata ◽

Toshitaka Morishima ◽

Isao Miyashiro ◽

...

Keyword(s):

Acute Myeloid Leukemia ◽

Data Analysis ◽

Clinical Outcomes ◽

Real World ◽

Myeloid Leukemia ◽

Population Based ◽

Real World Data ◽

Long Term Trends ◽

Acute Myeloid

Download Full-text

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

Annals of Hematology ◽

10.1007/s00277-019-03600-6 ◽

2019 ◽

Vol 98 (4) ◽

pp. 881-888 ◽

Cited By ~ 2

Author(s):

Govind B. Kanakasetty ◽

Chethan R ◽

Lakshmaiah K C ◽

Lokanatha Dasappa ◽

Linu Abraham Jacob ◽

...

Keyword(s):

Acute Myeloid Leukemia ◽

Comparative Analysis ◽

Real World ◽

Myeloid Leukemia ◽

Treatment Patterns ◽

Acute Myeloid

Download Full-text

De Novo and Secondary Acute Myeloid Leukemia, Real World Data on Outcomes from the French Nord-Pas-De-Calais Picardie Acute Myeloid Leukemia Observatory

Blood ◽

10.1182/blood.v128.22.4013.4013 ◽

2016 ◽

Vol 128 (22) ◽

pp. 4013-4013 ◽

Cited By ~ 3

Author(s):

Loïc Renaud ◽

Olivier Nibourel ◽

Celine Berthon ◽

Christophe Roumier ◽

Céline Rodriguez ◽

...

Keyword(s):

Overall Survival ◽

Acute Myeloid Leukemia ◽

Supportive Care ◽

Real World ◽

Myeloid Leukemia ◽

De Novo ◽

Secondary Aml ◽

Secondary Acute Myeloid Leukemia ◽

De Novo Aml ◽

Acute Myeloid

Abstract Background. Population-based registries may provide data complementary to that from clinical intervention studies. Registries with high coverage of the target population reduce the impact of selection on outcome and the subsequent problem with extrapolating data to nonstudied populations like secondary Acute Myeloid Leukemia (AML). Actually, secondary AML are frequently excluded from clinical trials so the registries constitute the only way to fine data for establishing recommendations for the management of these patients in the real world. Method. The French Nord-pas-de-calais Picardie AML observatory containing 1 582 AML patients diagnosed between 2000 and 2015. We compared 974 primary AML to 514 Secondary AML include AML arising from a pre-existing myelodysplastic (n=211), myeloproliferative (n=88) or myelodysplastic/myeloproliferative (n=57) disease and therapy related AML (t-AML) (n=158). Results. Median survival and 5 years overall survival were respectively 420 days [95%IC: 349-491] and 32% for patients with de novo AML; 157 days [95%IC: 118-196] and 7% for patients with secondary AML. 1101 patients were classified according to the MRC as favorable, intermediate and unfavorable, respectively 18(5.2%), 178(51.9%) and 147(42.9%) patients with secondary AML including 100(29.2%) complexes karyotypes and 117(15.4%), 468(61.7%) and 173(22.8%) patients with de novo AML including 121 (15.9%) complexes karyotypes. 987 patients were classified according to the ELN as favorable, intermediate-1, intermediate-2 and unfavorable for respectively 35(11.7%), 53(17.7%), 67(22.%) and 144(48.2%) patients with secondary AML and 219(31.8%), 167(24.%), 136(19.8%) and 166(24.1%) patients with de novo AML. The age at diagnosis was significantly different (p < 10-3) with a median of 72.6 years for secondary AML and 63.2 for de novo AML. 206 (40.4%) patients with secondary AML received demethylating agents versus 184 (19%) for de novo AML and 152(29%) received high dose chemotherapy (HDC) versus 619 (63.9%) patients with de novo AML. Best supportive care was the only treatment for 170 (17.5%) de novo AML and 164 (31.9%) secondary AML patients. For patients over than 60 years old, median survival and 5 years overall survival were respectively 182 days [95%IC: 136.5-127.4] and 12.9% for 559 patients with de novo AML; 128 days [95%IC: 95.0-161.0] and <4% for 413 patients with secondary AML. Conclusion. The poor prognosis of secondary and t- AML is confirmed by this registry study. Possible explanations for this worse outcome could be older age at diagnosis and increased frequency of complex karyotypes which lead to less intensive therapy or supportive care only. In this specific population, the choice of demethylating agent therapy was frequently made because of the weak efficacy of HDC and increased frequency of side effects in this vulnerable group. Disclosures No relevant conflicts of interest to declare.

Download Full-text