Temporal patterns and predictors of receiving no active treatment among older patients with acute myeloid leukemia in the United States: A population-level analysis
Temporal patterns and predictors of receiving no active treatment among older patients with acute myeloid leukemia in the United States: A population-level analysis
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DOI：
10.1002/cncr.32439
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发表时间：
2019-12-01
期刊：
影响因子：
6.2
通讯作者：
Wang, Rong
中科院分区：
文献类型：
--
作者：
Zeidan, Amer M.;Podoltsev, Nikolai A.;Wang, Rong
背景大多数急性髓细胞白血病（AML）患者在诊断时年龄>65岁，并且没有积极治疗。本研究的目的是确定美国老年AML患者的患病率、时间趋势和与未接受积极治疗（NAT）相关的因素。方法对2001年至2013年期间居住在美国的14，089例年龄≥ 66岁的AML患者的监测、流行病学和最终结果（SEER）-医疗保险数据进行回顾性分析。NAT定义为未接受任何化疗，包括低甲基化药物。多变量logistic回归模型被用来分析与NAT相关的社会人口统计学，临床和供应商特征。结果NAT患者的百分比随着时间的推移从2001年诊断的患者中的59.7%下降到2013年诊断的患者中的42.8%。整个队列的中位总生存期为诊断后82天。与接受积极治疗的患者相比，接受NAT治疗的患者生存率更差。与NAT发生率较高相关的变量包括年龄、某些社会人口学特征（家庭收入在最低四分位数以内、居住在美国东北部以外、未婚）和临床因素（≥ 3种合并症、精神障碍、近期住院和残疾）。结论：超过一半的居住在美国的老年AML患者没有接受任何积极的白血病导向治疗，尽管低强度治疗，如低甲基化剂的可用性。缺乏积极治疗与生存率降低相关。确定NAT的预测因子可能会提高这一患者人群的护理质量和生存率，特别是随着毒性较低的新型治疗选择的出现。
Background The majority of patients with acute myeloid leukemia (AML) are aged >65 years at the time of diagnosis and are not actively treated. The objective of the current study was to determine the prevalence, temporal trends, and factors associated with no active treatment (NAT) among older patients with AML in the United States. Methods A retrospective analysis was performed of Surveillance, Epidemiology, and End Results (SEER)-Medicare data from 14,089 patients with AML residing in the United States who were diagnosed with AML at age >= 66 years during 2001 through 2013. NAT was defined as not receiving any chemotherapy, including hypomethylating agents. Multivariable logistic regression models were used to analyze sociodemographic, clinical, and provider characteristics associated with NAT. Results The percentage of patients with NAT decreased over time from 59.7% among patients diagnosed in 2001 to 42.8% among those diagnosed in 2013. The median overall survival for the entire cohort was 82 days from the time of diagnosis. Patients treated with NAT had worse survival compared with those receiving active treatment. Variables found to be associated with higher odds of NAT included older age, certain sociodemographic characteristics (household income within the lowest quartile, residence outside the Northeast region of the United States, and being unmarried), and clinical factors (>= 3 comorbidities, the presence of mental disorders, recent hospitalization, and disability). Conclusions Greater than one-half of older patients with AML residing in the United States do not receive any active leukemia-directed therapy despite the availability of lower intensity therapies such as hypomethylating agents. Lack of active therapy receipt is associated with inferior survival. Identifying predictors of NAT might improve the quality of care and survival in this patient population, especially as novel therapeutic options with lower toxicity are becoming available.