scholarly journals Comparison of Hospital Length of Stay and Supportive Care Utilization Between Patients Treated with CPX-351 and 7+3 for Therapy-Related Acute Myeloid Leukemia or Acute Myeloid Leukemia with Myelodysplasia-Related Changes

2022 ◽  
Vol Volume 14 ◽  
pp. 21-34
Author(s):  
Kwanza Price ◽  
Zhun Cao ◽  
Craig Lipkin ◽  
Deb Profant ◽  
Scott Robinson
Keyword(s):  
Acute Myeloid Leukemia ◽  
Length Of Stay ◽  
Supportive Care ◽  
Myeloid Leukemia ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Care Utilization ◽  
Acute Myeloid

scholarly journals Health care utilization and end-of-life care for older patients with acute myeloid leukemia

Cancer ◽  
2015 ◽  
Vol 121 (16) ◽  
pp. 2840-2848 ◽  
Author(s):  
Areej R. El-Jawahri ◽  
Gregory A. Abel ◽  
David P. Steensma ◽  
Thomas W. LeBlanc ◽  
Amir T. Fathi ◽  
...  
Keyword(s):  
Health Care ◽  
Acute Myeloid Leukemia ◽  
Health Care Utilization ◽  
End Of Life ◽  
End Of Life Care ◽  
Older Patients ◽  
Myeloid Leukemia ◽  
Care Utilization ◽  
Life Care ◽  
Acute Myeloid

scholarly journals Intensive chemotherapy, azacitidine, or supportive care in older acute myeloid leukemia patients: An analysis from a regional healthcare network

2014 ◽  
Vol 89 (12) ◽  
pp. E244-E252 ◽  
Author(s):  
Pierre Bories ◽  
Sarah Bertoli ◽  
Emilie Bérard ◽  
Julie Laurent ◽  
Eliane Duchayne ◽  
...  
Keyword(s):  
Acute Myeloid Leukemia ◽  
Supportive Care ◽  
Myeloid Leukemia ◽  
Intensive Chemotherapy ◽  
Healthcare Network ◽  
Acute Myeloid

scholarly journals The Unique Supportive Care Needs of a Mother With Acute Myeloid Leukemia During Treatment

2015 ◽  
Vol 19 (1) ◽  
pp. 16-19 ◽  
Author(s):  
Tara Albrecht ◽  
AnnMarie Walton ◽  
Ashley Leak Bryant
Keyword(s):  
Acute Myeloid Leukemia ◽  
Supportive Care ◽  
Myeloid Leukemia ◽  
Supportive Care Needs ◽  
Care Needs ◽  
Acute Myeloid

scholarly journals Advances in Acute Myeloid Leukemia Management: Focus on Secondary Disease and Older Patients

2020 ◽  
Vol 18 (12.5) ◽  
pp. 1785-1787
Author(s):  
Daniel A. Pollyea
Keyword(s):  
Acute Myeloid Leukemia ◽  
Supportive Care ◽  
Older Patients ◽  
Myeloid Leukemia ◽  
Treatment Options ◽  
Management Strategies ◽  
Special Populations ◽  
Secondary Aml ◽  
Long Period ◽  
Acute Myeloid

The “Age of Induction” led to breakthroughs in the treatment landscape for acute myeloid leukemia (AML), and was immediately followed by a long period during which few drugs were approved. That all changed a few years ago, when 2017 began the “Age of Abundance.” With many treatment options now available, new management strategies have emerged for patients with secondary AML, as well as for older patients with AML. Treatment can now be tailored to these special populations, and providers should be aware of the unique supportive care considerations associated with these newer AML therapies.

scholarly journals Practice patterns and outcomes for adults with acute myeloid leukemia receiving care in community vs academic settings

Hematology ◽  
2020 ◽  
Vol 2020 (1) ◽  
pp. 129-134
Author(s):  
Anna B. Halpern ◽  
Roland B. Walter
Keyword(s):  
Acute Myeloid Leukemia ◽  
Supportive Care ◽  
Myeloid Leukemia ◽  
Hematopoietic Cell Transplantation ◽  
Community Setting ◽  
Early Death ◽  
Outpatient Setting ◽  
Academic Settings ◽  
The Impact ◽  
Acute Myeloid

Abstract Consistent with observations in other disease settings, retrospective studies have indicated that treatment outcomes for adults with acute myeloid leukemia (AML) are better in higher- vs lower-volume hospitals and academic vs nonacademic centers, with greatest benefits noted in acute promyelocytic leukemia. Younger age, more frequent receipt of chemotherapy and hematopoietic cell transplantation, and differences in comorbidities and socioeconomic factors may partially account for these differences. With new therapeutic options including oral small molecule inhibitors and parenteral drugs suitable for outpatient administration, there is increasing interest from patients and physicians in treating AML in the community setting and avoiding referral to academic centers. This may be particularly true for older adults, for whom treatment rates in the community have historically been low, and for those with comorbidities, because treatment benefits are estimated to be low, and thus travel to academic centers is perceived as especially burdensome. How the volume-outcome relationship is affected by the shift of the treatment landscape in AML over the last few years is unknown. Additionally, improvements in supportive care (transfusion support, broad-spectrum oral antimicrobials), resulting in gradually decreasing early death rates over time, and the growing focus on the impact of AML therapy on quality of life and treatment cost concerns further fuel the larger trend toward an increasing proportion of care delivered in the outpatient setting. Here, we examine whether the current shift of administering chemotherapy and supportive care to the outpatient setting can be translated to the community setting without compromising patient outcomes.

Trends in Outcomes and Charges of Acute Myeloid Leukemia in the Elderly: A Cross-Sectional Analysis of the Nationwide Inpatient Sample from 1993 to 2001.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 3142-3142
Author(s):  
Laura M. Katz ◽  
Lee S. Stern ◽  
John M. Fastenau ◽  
Catherine T. Piech ◽  
John J. Doyle
Keyword(s):  
Acute Myeloid Leukemia ◽  
Length Of Stay ◽  
Myeloid Leukemia ◽  
Nationwide Inpatient Sample ◽  
The Elderly ◽  
Inpatient Mortality ◽  
Patient Death ◽  
Weighted Mean ◽  
Cross Sectional ◽  
Acute Myeloid

Abstract Background: Acute myeloid leukemia (AML) is a malignant disorder of the blood with an incidence almost ten times greater among persons 65 years and older than among those younger than 65 years (12.2 vs. 1.3 per 100,000) (Arch Intern Med2002;162:1597–1603). Treatment includes conventional cytotoxic chemotherapy [e.g., the “7+3” regimen consisting of cytarabine and daunorubicin or idarubicin (Leukemia1996;10:389–95)], which can be associated with serious morbidity and is often not tolerated by older patients. The five-year survival rate for AML is 2% among elderly patients and has not improved appreciably in the past two decades (Arch Intern Med2002;162:1597–1603). Methods: A cross-sectional study was conducted using the Nationwide Inpatient Sample (NIS), a national all-payer inpatient database drawn from 1,000 hospitals, which is part of the Healthcare Cost and Utilization Project (HCUP). Data on AML patients aged 60 years and older from 1998 to 2001 were analyzed for descriptives (demographics and hospital characteristics), comorbidities, outcomes, resource utilization, and charges. Admission mortality, length of stay (LOS), and charges were calculated for AML patients for each year of NIS data from 1993 to 2001 and were weighted using the NIS weighting scheme to adjust for sampling differences across years. Results: Of all AML admissions from 1998 to 2001 (n=15,327), the mean age was 72.6 years (SD=7.8), and females accounted for 44.6% of admissions. Patients aged 60 to 74 accounted for 61.0% of admissions over these years, whereas patients aged 75 to 84 and 85 and older accounted for only 31.0% and 8.0% of admissions, respectively. Mean LOS per admission was 12.3 days between 1998 and 2001, with a median of 7.0 days. While the majority of these admissions (66.8%) involved discharge to home, patient death occurred in 20.2% of admissions, and the remainder resulted in discharge to other healthcare facilities. Weighted mean admission charges increased overall from 1993 to 2001; mean charges increased steadily from 1993 until 1997 (from $34,222 to $35,781, respectively), at which point they increased at a sharper rate for the remaining years (from $35,781 in 1997 to $47,786 in 2001) (Table 1). Conversely, weighted mean LOS decreased from 14.9 to 12.2 days during the same years, while mortality rates decreased from 23.9% to 20.2%. Conclusion: Hospitalization charges for elderly AML patients increased overall from 1993 to 2001, with the sharpest increase over the latter four years. This increase in charges occurred in contrast with overall decreases in LOS and mortality. Table 1: Inpatient Mortality, Length of Stay (LOS) Per Admission, and Charges Per Admission by Year Year Inpatient Mortality LOS Per Admission (Days) Charges Per Admission ($) Percent Mean SE Mean SE 1993 23.9 14.94 0.48 34,222 1,647 1994 24.7 14.28 0.45 35,243 1,840 1995 22.3 13.48 0.43 34,920 1,996 1996 22.2 13.23 0.46 36,257 1,698 1997 21.9 12.63 0.41 35,781 1,611 1998 19.8 12.55 0.36 37,176 1,452 1999 20.0 12.52 0.34 40,897 2,047 2000 20.4 12.03 0.31 45,759 2,362 2001 20.2 12.23 0.45 47,786 2,875

Acute Myeloid Leukemia (AML). Diagnosis, Therapy and Outcome Results from Tawam Hospital. a Retrospective Review

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 5254-5254
Author(s):  
Arif Alam ◽  
Ali Tahir ◽  
Masood H Syed ◽  
Sabir Hussain ◽  
Amar Lal ◽  
...  
Keyword(s):  
Older Adults ◽  
Acute Myeloid Leukemia ◽  
Supportive Care ◽  
Induction Therapy ◽  
Myeloid Leukemia ◽  
Performance Status ◽  
High Dose ◽  
Lost To Follow Up ◽  
Acute Myeloid

Abstract Introduction Acute Myeloid leukemia (AML) is a heterogeneous group of malignant disorders of myeloid hematopoetic cells. These cells have a maturation arrest in different stages of development leading to accumulation of immature cells. This gives rise to the different symptoms and signs of disease secondary to anemia, thrombocytopenia and neutropenia. The current WHO classification broadly divides AML into 4 main groups based on morphology, immunophenotyping, genetics and clinical features. These include AML with recurrent genetic abnormalities, AML with myelodysplasia related changes; therapy related AML and AML not otherwise specified (NOS). Therapeutically AML can be divided into 2 main groups; Acute promyelocytic leukemia (APML) and non APML. Methods Tawam Tumor registry was searched for patients with diagnosis of AML from January 2010 till December 2012. Patient records were then reviewed and data was collected. Results We identified 49 patients with pathologically confirmed diagnosis of AML. 19/49 patients were diagnosed with AML with recurrent cytogenetic, 5/49 with MDS related or therapy related and 25 with AML NOS Cytogenetic Analysis of this cohort of 49 patients with AML showed that 15 patients (30%) had APML with 15;17 translocation, 4 patients had 8;21 translocation, 5 had complex or poor risk cytogenetic while 13 had normal karyotype. In 12/49 patients Karyotyping failed due to growth failure. Status of FLT3 and NPM1 are not known for the entire cohort. Demographics The median age of the cohort was 38 years (range 20 to 84 years). Older adults (age 65 years or more) make a minority of this cohort (8%). Male to female ration was 3.5:1. Treatment In patients with Non APML Induction therapy was a combination of Cytarabine and Idarubicin for adults < 65 years of age and with good performance status. Older adults or adults with poor performance status or co-morbidities were either given hypomehtylating agents, Clofarabine or supportive care. Patients achieving complete remission (CR) were given consolidation with High Dose Cytarabine (HIDAC) as per CALGB protocol. Only a minority of patients were able to go for allogeneic stem cell transplantation in CR1 Patients with APML were treated with ATRA, Idarubicin/Mitoxantrone and Cytarabine as per PETHEMA protocol on a risk adjusted plan. This was followed by 2 year maintenance with ATRA, 6 MP and Methotrexate. Outcome of Treatment In non APML patients 62 % (17) achieved CR with induction therapy. Induction therapy failure was observed in 18 % (5) while there were 5 early deaths observed (during aplasia). 7 patients were treated with hypomethylating agents or best supportive care. Only 1patient was able to achieve CR (after cycle 4 of 5-azacitidine). Consolidation therapy was given to 17 patients achieving CR. With a median follow up of 15 months (range 9-24 months) 9 patients are alive and disease free while 17 patients have been lost to follow up. 8 out of these 17 patients were in remission at their last follow up. In APML patients the CR rate was 93%. There were no cases of induction failure and only 1 case of early death (7%) due to hemorrhage. With a median follow up of 17 months (range 11-41 months) 11 patients are in molecular CR while 3 have been lost to follow up. Conclusion This is the first analysis of patients who were diagnosed with AML in a tertiary care center in UAE. The results show that the median age of patients our cohort is low as compared to international reports (approximately 38 vs. 65 years). Older adults (> 65 years of age) make only a minority of the AML cohort in Tawam Hospital. Response to induction therapy is comparable to international standards (60-80%) for AML and > 90% for APML. We also report a twofold higher incidence of APML as compared to internationally reported data (30% vs.12%). This has a very significant diagnostic and therapeutic impact on the management of AML patients at our institute leading to increase vigilance and institution of ATRA at the earliest clinical suspicion of APML. Disclosures Alam: BMS: Consultancy, Honoraria; Novartis: Consultancy, Honoraria. Hussain:BMS: Honoraria; Novartis: Honoraria. Lal:BMS: Honoraria; novartis: Honoraria.

On the value of intensive remission-induction chemotherapy in elderly patients of 65+ years with acute myeloid leukemia: a randomized phase III study of the European Organization for Research and Treatment of Cancer Leukemia Group.

1989 ◽  
Vol 7 (9) ◽  
pp. 1268-1274 ◽  
Author(s):  
B Löwenberg ◽  
R Zittoun ◽  
H Kerkhofs ◽  
U Jehn ◽  
J Abels ◽  
...  
Keyword(s):  
Acute Myeloid Leukemia ◽  
Supportive Care ◽  
Induction Chemotherapy ◽  
Myeloid Leukemia ◽  
Survival Outcome ◽  
Phase Iii ◽  
Survival Duration ◽  
Remission Induction ◽  
Wait And See ◽  
Acute Myeloid

We report the results of a prospective study in patients more than 65 years of age in whom two different therapeutic strategies were compared: immediate intensive-induction chemotherapy (arm A) versus "wait and see" and supportive care and mild cytoreductive chemotherapy only for relief of progressive acute myeloid leukemia (AML)-related symptoms (arm B). The major objective of the study was to compare survival outcome of both regimens. Thirty-one patients on arm A received one or two courses of daunorubicin, vincristine, and cytarabine for remission induction followed by one additional cycle for consolidation in case of complete remission (CR). Among 29 patients on arm B, cytoreductive chemotherapy (hydroxyurea, cytarabine) had to be initiated for palliation of leukemia-associated complications in 21 patients at a median of 9 days after diagnosis. Overall survival duration for patients treated on arm A was significantly (P = .015) longer than the survival in arm B (median survival, 21 weeks v 11 weeks; projected survival at 2.5 years, 13% v 0%). Eighteen (58%) of arm A patients and none (0%) of arm B patients entered CR. Of the first group, projected disease-free survival at 2 years is 17%. The median percentages of days spent in the hospital by arm A and B patients were 55% and 50%, respectively. This study shows that a strategy based on modern supportive care and a wait and see approach yields extremely poor results. It is not superior in regard to the frequency of hospital admission and is inferior regarding survival outcome.

scholarly journals 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 ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 4013-4013 ◽  
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.

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