Background: Acute Myeloid Leukemia (AML) is an aggressive and most common hematologic malignancy in adults with a higher incidence in older adults with a median age of diagnosis of 68 years. It accounts for the largest number of annual deaths from leukemias in the United States. Several new therapies have been approved after many years and are expected to impact patient outcomes, especially in patients aged 60 and above.

Design/Methods: We conducted a retrospective analysis of AML patients aged 60 years and above, diagnosed between 2000 and 2021, using the SEER database. Variables such age, gender, race, chemotherapy, and survival outcomes in the last 5 years were extracted and analyzed. Kaplan-Meier survival analysis was performed to evaluate overall survival (OS).

Results: The study included 51,778 AML patients aged 60 years and above. 55.9% were male, and 44.1% were female. The racial distribution was 85.3% white, 6.8% black, 7.2% Asian/Pacific Islander, and 0.6% from other racial backgrounds. Among these only 58.4% of patients received chemotherapy in patients aged 60 and above. Patients who received chemotherapy had median OS of 7 months compared to 1 month in patients who did not receive chemotherapy. Patients who received chemotherapy has significantly reduced risk of death, with hazard ratio of 0.53 (95% CI: 0.42-0.68) and a p-value < 0.01, indicating a 47% reduction in risk of death. The median overall survival (OS) in older patients including patients with and without chemotherapy was 2 months, and 5-year survival rate is 8.3% for Age ≥ 60 years. The results from the multivariate Cox proportional hazards model indicate that, compared to the reference group aged 60-64 years, the hazard ratios (HR) for the age groups 65-69, 70-74, 75-79, 80-84, and 85+ are 1.23 (95% CI: 1.19-1.28), 1.48 (95% CI: 1.43-1.53), 1.79 (95% CI: 1.73-1.85), 2.00 (95% CI: 1.93-2.07), and 2.40 (95% CI: 2.32-2.50) respectively, with all p-values < 0.01. This indicates a statistically significant increase in risk with advancing age, with the 85+ age group having a 140% higher risk compared to the reference group.

Conclusion: This analysis of SEER data highlights that despite advances in treatment, survival outcomes remain poor, in older patients aged 60 and above with AML. A significant percentage was unable to get chemotherapy, and it determines significant challenges in managing this population. These findings emphasize the need for novel therapeutic approaches and strategies to improve outcomes in older AML patients.

Disclosures

No relevant conflicts of interest to declare.

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2024
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