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Original Article

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Blood Res 2014; 49(2):

Published online June 25, 2014

https://doi.org/10.5045/br.2014.49.2.95

© The Korean Society of Hematology

Clinical characteristics and treatment outcome of acute myeloid leukemia in elderly patients in Korea: a retrospective analysis

Hyeon Gyu Yi1, Moon Hee Lee1, Chul Soo Kim1, Junsik Hong2, Jinny Park2, Jae Hoon Lee2, Bo Ram Han3, Ho Young Kim3, Dae Young Zang3, Se Hyung Kim4, Seong Kyu Park4, Dae Sik Hong4, Guk Jin Lee5, Jong-Youl Jin5*, and Gyeonggi/Incheon Branch, The Korean Society of Hematology

Author Info. +

1Department of Internal Medicine, Inha University Hospital, Inha University, Incheon, Korea.

2Department of Internal Medicine, Gachon University Gil Medical Center, Gachon University School of Medicine, Incheon, Korea.

3Department of Internal Medicine, Hallym University Medical Center, Hallym University, Anyang, Korea.

4Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University, Bucheon, Korea.

5Department of Internal Medicine, Bucheon St. Mary's Hospital, The Catholic University of Korea, Bucheon, Korea.

Correspondence to : Correspondence to Jong-Youl Jin, M.D., Ph.D. Department of Internal Medicine, Bucheon St. Mary's Hospital, The Catholic University of Korea, 327 Sosa-ro, Wonmi-gu, Bucheon 420-717, Korea. Tel: +82-32-890-2587, Fax: +82-32-890-2585, drjin@catholic.ac.kr

Received: October 7, 2013; Revised: March 1, 2014; Accepted: May 13, 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

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Background

The clinical characteristics of elderly patients with AML differ from those of younger patients, resulting in poorer survival and treatment outcomes. We analyzed retrospectively the clinical data of AML patients 65 years old and above to describe patients' characteristics and treatment patterns, and to define meaningful prognostic factors of survival in the Korean population.

Methods

Basic patients' characteristics, clinical outcomes according to treatments, and prognostic factors associated with survival and treatment intensity were examined in a total of 168 patients diagnosed in 5 institutes between 1996 and 2012 as having AML.

Results

Herein, 84 patients (50.0%) received high-intensity regimens (HIR), 18 (10.7%) received low-intensity regimens (LIR), and 66 (39.3%) received supportive care (SC) only. The median survival of all patients was 4.5 months; and median survival times with HIR, LIR, and SC were 6.8 months, 10.2 months, and 1.6 months, respectively. Median survival times with HIR and LIR were significantly longer than that with SC (P<0.0001 and P=0.006, respectively). Multivariate analysis identified age, Eastern Cooperative Oncology Group-performance status (ECOG-PS), hemoglobin (Hb) level, and serum creatinine (Cr) level as statistically significant prognostic factors for survival. In the HIR group, prognostic factors for survival were ECOG-PS, Hb level, and C-reactive protein level.

Conclusion

Even in elderly AML patients, an intensive treatment regimen could be beneficial with careful patient selection. Further prospective studies designed to identify specific prognostic factors are required to establish an optimal treatment strategy for elderly AML patients.

Keywords Acute myeloid leukemia, Survival, Prognosis, Chemotherapy, Elderly

Article

Original Article

Blood Res 2014; 49(2): 95-99

Published online June 25, 2014 https://doi.org/10.5045/br.2014.49.2.95

Copyright © The Korean Society of Hematology.

Clinical characteristics and treatment outcome of acute myeloid leukemia in elderly patients in Korea: a retrospective analysis

Hyeon Gyu Yi1, Moon Hee Lee1, Chul Soo Kim1, Junsik Hong2, Jinny Park2, Jae Hoon Lee2, Bo Ram Han3, Ho Young Kim3, Dae Young Zang3, Se Hyung Kim4, Seong Kyu Park4, Dae Sik Hong4, Guk Jin Lee5, Jong-Youl Jin5*, and Gyeonggi/Incheon Branch, The Korean Society of Hematology

1Department of Internal Medicine, Inha University Hospital, Inha University, Incheon, Korea.

2Department of Internal Medicine, Gachon University Gil Medical Center, Gachon University School of Medicine, Incheon, Korea.

3Department of Internal Medicine, Hallym University Medical Center, Hallym University, Anyang, Korea.

4Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University, Bucheon, Korea.

5Department of Internal Medicine, Bucheon St. Mary's Hospital, The Catholic University of Korea, Bucheon, Korea.

Correspondence to: Correspondence to Jong-Youl Jin, M.D., Ph.D. Department of Internal Medicine, Bucheon St. Mary's Hospital, The Catholic University of Korea, 327 Sosa-ro, Wonmi-gu, Bucheon 420-717, Korea. Tel: +82-32-890-2587, Fax: +82-32-890-2585, drjin@catholic.ac.kr

Received: October 7, 2013; Revised: March 1, 2014; Accepted: May 13, 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

The clinical characteristics of elderly patients with AML differ from those of younger patients, resulting in poorer survival and treatment outcomes. We analyzed retrospectively the clinical data of AML patients 65 years old and above to describe patients' characteristics and treatment patterns, and to define meaningful prognostic factors of survival in the Korean population.

Methods

Basic patients' characteristics, clinical outcomes according to treatments, and prognostic factors associated with survival and treatment intensity were examined in a total of 168 patients diagnosed in 5 institutes between 1996 and 2012 as having AML.

Results

Herein, 84 patients (50.0%) received high-intensity regimens (HIR), 18 (10.7%) received low-intensity regimens (LIR), and 66 (39.3%) received supportive care (SC) only. The median survival of all patients was 4.5 months; and median survival times with HIR, LIR, and SC were 6.8 months, 10.2 months, and 1.6 months, respectively. Median survival times with HIR and LIR were significantly longer than that with SC (P<0.0001 and P=0.006, respectively). Multivariate analysis identified age, Eastern Cooperative Oncology Group-performance status (ECOG-PS), hemoglobin (Hb) level, and serum creatinine (Cr) level as statistically significant prognostic factors for survival. In the HIR group, prognostic factors for survival were ECOG-PS, Hb level, and C-reactive protein level.

Conclusion

Even in elderly AML patients, an intensive treatment regimen could be beneficial with careful patient selection. Further prospective studies designed to identify specific prognostic factors are required to establish an optimal treatment strategy for elderly AML patients.

Keywords: Acute myeloid leukemia, Survival, Prognosis, Chemotherapy, Elderly

Fig 1.

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Figure 1.

(A) The median survival of all patients was 4.5 months (95% CI: 2.4-6.7 months). (B) Kaplan-Meier analysis of overall survival according to the cytogenetic risk group.

Blood Research 2014; 49: 95-99https://doi.org/10.5045/br.2014.49.2.95

Fig 2.

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Figure 2.

(A) Survival comparison according to treatment intensity showed that median survivals in the HIR and LIR groups were significantly longer than that in the SC group. There was no difference in median survival between the HIR and the LIR group. (B) In the intermediate risk group, median survivals in the HIR and LIR groups were significantly longer than that in the SC group (P=0.031). There was no difference in median survival between the HIR and the LIR group. Abbreviations: HIR, high-intensity regimen; LIR, low-intensity regimen; SC, supportive care.

Blood Research 2014; 49: 95-99https://doi.org/10.5045/br.2014.49.2.95

Fig 3.

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Figure 3.

In the high-intensity regimen group, survival of the patients showing complete remission (CR) was significantly longer than that of patients who did not show CR (non-CR) (P<0.0001).

Blood Research 2014; 49: 95-99https://doi.org/10.5045/br.2014.49.2.95

Table 1 . Patients' characteristics (N=168)..

Risk groups were defined according to the Southwest Oncology Group and Medical Research Council criteria..

Abbreviations: ECOG-PS, Eastern Cooperative Oncology Group performance status; HCT-CI, hematopoietic stem cell transplantation comorbidity index..

Table 2 . Patterns of induction treatment..

Abbreviations: reduced, reduced dose or infusion day compared to original regimen; FLAG, fludarabine, cytarabine, and G-CSF; FLAI, fludarabine, cytarabine, and idarubicin..

Table 3 . Clinical outcomes according to treatment intensity..


Table 4 . Prognostic factors for survival in all patients..

Abbreviations: ECOG-PS, Eastern Cooperative Oncology Group performance status; Hb, hemoglobin; CI, confidence interval..

Table 5 . Prognostic factors for survival in high-intensity regimen group..

Abbreviations: ECOG-PS, ECOG performance status; CRP, C-reactive protein..
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