Background

Survival in Acute myeloid leukemia (AML) has improved in younger patients over the last decade. Though chemotherapy has not changed significantly, better patient care may have improved survival in AML patients. This study was conducted to evaluate the relative survival rates in older AML patients over two decades in the United States.

Methods

Newly diagnosed AML (first primary only) in older (age≥75 years) patients were selected from the Surveillance, Epidemiology, and End Results (SEER) database. We analyzed SEER 18 registry database to evaluate relative survival rate in older (≥75 years) AML population diagnosed during 1992-2000. We selected AML patients from 13 SEER registries to compare RS during 1992-2000 and 2001-2009. The relative survival rates at 1 and 5 year were analyzed for various cohorts categorized by race (White, African-Americans (AA) & other), gender & age (≥75-84 and ≥85 years). The relative survival rates accompany standard error (SE). We used SEER-Stat, statistical software provided by NCI for statistical analysis.

Results

The relative survival rates improved significantly during 2001-2009 compared to 1992-2000 for all age groups, sex. For young elderly patients (≥75-84 years) RS increased from 13.1±0.8% to 17.4±0.9% at 1 year Z value=3.98, P<0.0001 and from 2.0±0.4 to 2.6±0.5%, Z value= 3.61, P<0.0005 at 5 years with improvement in median relative survival from 2.41 to 2.75 months.

Similarly, for very elderly (≥85 years) patients RS increased from 5.3±1.0% to 8.0±1.0%, Z value=3.03, P<0.005 at 1 year, 0.7±0.4% to 1.3±0.5% at 3 years Z value= 2.81, P=0.005, but no improvement seen at 5 years. There was significant improvement in RS from 1992-2000 to 2001-2009 in both sexes, caucasian and other races. There was no improvement in RS at 1 year and 5 year for older AA population. (Table)

Cohort 1992-2000 (n)=2,430 2001-2009(n)=2,8211 year relative survival % (± SE)
Z Value/ P value5 year relative survival % (± SE)
Z value/ p value
1992-20002001-20091992-20002001-2009
Age years ≥75-84 13.1(±0.8) 17.4(±0.9) 3.98/<0.0001 2.0(±0.4) 2.6(±0.5) 3.61/<0.001 
≥85 5.3(±1.0) 8.0(±1.0) 3.03/<0.005 0.6(±0.4) 0.0(±0.0) - 
sex Male 10.5(±0.9) 15.5(±1.0) 3.70/<0.0005 1.3(±0.4) 2.1(±0.5) 3.29/<0.001 
Female 11.8 (±1.0) 14.0(±1.0) 2.43/<0.05 2.0(±0.5) 1.8(±0.5) 2.37/<0.05 
Race Caucasian 11.4( ±0.7) 14.7(±0.8) 3.65/<0.0005 1.6(±0.3) 2.0(±0.4) 3.36/<0.001 
African American 9.3 (±2.6) 13.5(±2.8) 0.18/NS 0.9(±0.0) 0.9(±0.9) 0.50/ NS 
Other 9.7 (±2.3) 16.0(±2.2) 2.97/<0.005 2.8(±1.4) 2.8(±1.3) 2.62/<0.01 
Cohort 1992-2000 (n)=2,430 2001-2009(n)=2,8211 year relative survival % (± SE)
Z Value/ P value5 year relative survival % (± SE)
Z value/ p value
1992-20002001-20091992-20002001-2009
Age years ≥75-84 13.1(±0.8) 17.4(±0.9) 3.98/<0.0001 2.0(±0.4) 2.6(±0.5) 3.61/<0.001 
≥85 5.3(±1.0) 8.0(±1.0) 3.03/<0.005 0.6(±0.4) 0.0(±0.0) - 
sex Male 10.5(±0.9) 15.5(±1.0) 3.70/<0.0005 1.3(±0.4) 2.1(±0.5) 3.29/<0.001 
Female 11.8 (±1.0) 14.0(±1.0) 2.43/<0.05 2.0(±0.5) 1.8(±0.5) 2.37/<0.05 
Race Caucasian 11.4( ±0.7) 14.7(±0.8) 3.65/<0.0005 1.6(±0.3) 2.0(±0.4) 3.36/<0.001 
African American 9.3 (±2.6) 13.5(±2.8) 0.18/NS 0.9(±0.0) 0.9(±0.9) 0.50/ NS 
Other 9.7 (±2.3) 16.0(±2.2) 2.97/<0.005 2.8(±1.4) 2.8(±1.3) 2.62/<0.01 

NS: not significant

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Conclusion

The relative survival in elderly AML has increased significantly during 2001-2009 compared to 1992-2000. The RS improved both at 1 year and 5 years for young elderly patients. Improvement in RS was observed at 1 year and 3 years for very elderly (>85 years) AML patients.

Disclosures:

No relevant conflicts of interest to declare.

Topics:
leukemia, myelocytic, acute, older adult, chemotherapy regimen, standard error, software

Author notes

*

Asterisk with author names denotes non-ASH members.

© 2013 by The American Society of Hematology
2013
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