Improved patient survival for acute myeloid leukemia: a population-based study of 9729 patients diagnosed in Sweden between 1973 and 2005

AbstractWe evaluated survival patterns for all registered acute myeloid leukemia (AML) patients diagnosed in Sweden in 1973 to 2005 (N = 9729; median age, 69 years). Patients were categorized into 6 age groups and 4 calendar periods (1973-1980, 1981-1988, 1989-1996, and 1997-2005). Relative survival ratios were computed as measures of patient survival. One-year survival improved over time in all age groups, whereas 5- and 10-year survival improved in all age groups, except for patients 80+ years. The 5-year relative survival ratios in the last calendar period were 0.65, 0.58, 0.36, 0.15, 0.05, and 0.01 for the age groups 0 to 18, 19 to 40, 41 to 60, 61 to 70, 71 to 80, and 80+ years, respectively. Intensified chemotherapy, a continuous improvement in supportive care, and allogeneic stem cell transplantation are probably the most important factors contributing to this finding. In contrast, there was no improvement in survival in AML patients with a prior diagnosis of a myelodysplastic syndrome during 1993 to 2005 (n = 219). In conclusion, AML survival has improved during the last decades. However, the majority of AML patients die of their disease and age remains an important predictor of prognosis. New effective agents with a more favorable toxicity profile are needed to improve survival, particularly in the elderly.

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Temporal Trends in the Proportion Cured Among Patients Diagnosed with Acute Myeloid Leukemia in Sweden 1973-2001, a Population-Based Study.

Blood ◽

10.1182/blood.v114.22.1378.1378 ◽

2009 ◽

Vol 114 (22) ◽

pp. 1378-1378

Author(s):

Åsa Rangert Derolf ◽

Therese M-L Andersson ◽

Paul C Lambert ◽

Sigurdur Y Kristinsson ◽

Sandra Eloranta ◽

...

Keyword(s):

Acute Myeloid Leukemia ◽

Myeloid Leukemia ◽

Patient Survival ◽

Age Groups ◽

Population Based ◽

Age Group ◽

Survival Times ◽

Population Based Study ◽

Cure Fraction ◽

Acute Myeloid

Abstract Abstract 1378 Poster Board I-400 Background: Acute myeloid leukemia (AML) is the most common type of acute leukemia in adults and is rapidly fatal without specific therapy. In a recently published population-based study we showed large differences in 1- and 5-year relative survival in AML patients in Sweden depending on age at diagnosis and year of diagnosis[1]. Here we use an alternative approach to study patient survival that simultaneously estimates the proportion of patients cured from AML and the survival time of those patients that are not cured. The cure proportion provides a better estimate of long-term survival than 5-year survival and is therefore of direct interest to patients and health care professions. Methods: We conducted a population-based cohort study including 6,439 patients aged 19-79 diagnosed with AML in Sweden 1973 to 2001. Patients are considered statistically cured when, as a group, their mortality returns the level of a comparable general population. We estimated mixture cure fraction models that provide estimates of both the cure proportion and the distribution of survival times of the “uncured”. Age at diagnosis was classified into four categories 19-40, 41-60, 61-70 and 71-80 and year of diagnosis was modeled using restricted cubic splines. Results: During the first years of the study period the cure fraction was less than 5% for all age groups and the median survival time for “uncured” approximately 0.5 years or less. In 2000 the estimated cure proportion was 68% (95% CI 56%-77%) for the youngest age group, 32% (25-39%) for those aged 41-60, 8.4% (3.1-21%) for those aged 61-70 at diagnosis and 4.3% (2.3-8.1%) for the oldest age group. The estimated median survival times for “uncured” were 0.74 (0.43-1.26), 0.71 (0.53-0.97), 0.69 (0.51-0.95) and 0.37 (0.31-0.44) years respectively (Table 1). The improvement in survival manifested as longer survival among the uncured during the early calendar years but increases in the cure proportion were observed during later years. Conclusion: There are large differences in the proportion cured between the age groups. In younger patients the cure proportion has increased dramatically, while survival of the “uncured” actually decreased in the last time period. In the older age groups improvement is merely seen within the survival of the “uncured”. [1] Derolf AR, Kristinsson SY, Andersson TM-L, Landgren O, Dickman PW, Björkholm M. Improved patient survival for acute myeloid leukemia: A population-based study of 9,729 patients diagnosed in Sweden 1973-2005. Blood. 2009 Apr 16;113(16):3666-72. Disclosures: No relevant conflicts of interest to declare.

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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

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Success Story of Targeted Therapy in Chronic Myeloid Leukemia: A Population-Based Study of Patients Diagnosed in Sweden From 1973 to 2008

Journal of Clinical Oncology ◽

10.1200/jco.2011.34.7146 ◽

2011 ◽

Vol 29 (18) ◽

pp. 2514-2520 ◽

Cited By ~ 137

Author(s):

Magnus Björkholm ◽

Lotta Ohm ◽

Sandra Eloranta ◽

Åsa Derolf ◽

Malin Hultcrantz ◽

...

Keyword(s):

Chronic Myeloid Leukemia ◽

Myeloid Leukemia ◽

Kinase Inhibitor ◽

Large Population ◽

Age Groups ◽

Relative Survival ◽

The Elderly ◽

Population Based ◽

Population Based Study ◽

First Line Therapy

Purpose Chronic myeloid leukemia (CML) management changed dramatically with the development of imatinib mesylate (IM), the first tyrosine kinase inhibitor targeting the BCR-ABL1 oncoprotein. In Sweden, the drug was approved in November 2001. We report relative survival (RS) of patients with CML diagnosed during a 36-year period. Patients and Methods Using data from the population-based Swedish Cancer Registry and population life tables, we estimated RS for all patients diagnosed with CML from 1973 to 2008 (n = 3,173; 1,796 males and 1,377 females; median age, 62 years). Patients were categorized into five age groups and five calendar periods, the last being 2001 to 2008. Information on use of upfront IM was collected from the Swedish CML registry. Results Relative survival improved with each calendar period, with the greatest improvement between 1994-2000 and 2001-2008. Five-year cumulative relative survival ratios (95% Cls) were 0.21 (0.17 to 0.24) for patients diagnosed 1973-1979, 0.54 (0.50 to 0.58) for 1994-2000, and 0.80 (0.75 to 0.83) for 2001-2008. This improvement was confined to patients younger than 79 years of age. Five-year RSRs for patients diagnosed from 2001 to 2008 were 0.91 (95% CI, 0.85 to 0.94) and 0.25 (95% CI, 0.10 to 0.47) for patients younger than 50 and older than 79 years, respectively. Men had inferior outcome. Upfront overall use of IM increased from 40% (2002) to 84% (2006). Only 18% of patients older than 80 years of age received IM as first-line therapy. Conclusion This large population-based study shows a major improvement in outcome of patients with CML up to 79 years of age diagnosed from 2001 to 2008, mainly caused by an increasing use of IM. The elderly still have poorer outcome, partly because of a limited use of IM.

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

Journal of Clinical Oncology ◽

10.1200/jco.2004.22.14_suppl.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

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Age and Population-Based Early Mortality Rate (EMR) in Acute Myeloid Leukemia (AML) Versus the EMR Reported By SWOG

Blood ◽

10.1182/blood.v124.21.3665.3665 ◽

2014 ◽

Vol 124 (21) ◽

pp. 3665-3665

Author(s):

George Yaghmour ◽

Andrew Hahn ◽

Michael G Martin

Keyword(s):

Acute Myeloid Leukemia ◽

Myeloid Leukemia ◽

Conflicts Of Interest ◽

Age Distribution ◽

Age Groups ◽

Population Based ◽

P Value ◽

Seminal Paper ◽

Chi Squared ◽

Acute Myeloid

Abstract Background: In their seminal paper SWOG described the expected EMR for patients by age enrolled on clinical trials in AML (Appelbaum et al Blood 2006; 107: 3481-5). We sought to contrast these to population based outcomes. Methods: Using case listing session of SEER 18 (1973-2010) we identified patients (pt) 18 years of age and older diagnosed (dx) from 1990-2005 with AML (Site recode ICD-O-3/WHO 2008 Acute Myeloid Leukemia which includes ICD-0-3 9861/3, 9873/3, 9920/3, 9910/3, 9840/3, 9891/3, 9867/3, and 9895/3 and includes all FAB and WHO subtypes except M3 ). This was done in order to match the accrual periods of the SWOG studies. We then examined the EMR of pt with non-M3 AML and compared them to those reported by SWOG. EMR in SEER was defined as death within 0 to 1 month from dx; EMR in the SWOG studies was defined as death within 30 days of initiation of induction chemotherapy. Analyses were conducted with SEER*Stat 8.1.2, Microsoft Excel 2007 and GraphPad Prism 6. All p-values were 2-sided. Results: 26,272 pt were identified within SEER and 955 pt were in the SWOG EMR cohort. 54% of patients were male in SEER and 55% were male in SWOG; 85% of patients were white in SEER and 89% were white in SWOG. The EMR was 38.6% (10,130) in the SEER cohort; EMR was 12.2% (116) in the SWOG cohort (chi-squared with Yates correction p<0.001). Age distribution and mortality by age are presented in the table below. In general the SEER patients were older and experienced a two-fold greater EMR than SWOG patients in each age subgroup. Conclusion: EMR in pt with non-M3 AML is much higher across all studied age groups in population based data than reported in SWOG studies. TableSEERSWOGEMR Fisher’s exact p-value% of ptEMR% of ptEMR<562616383P<0.00156-6516282511P<0.00166-7526412820P<0.001>753260832P<0.001 Disclosures No relevant conflicts of interest to declare.

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