TY - JOUR
T1 - Attitude towards remission induction for elderly patients with acute myeloid leukemia influences survival.
AU - Juliusson, Gunnar
AU - Billstrom, R
AU - Gruber, A
AU - Hellstrom-Lindberg, E
AU - Hoglund, M
AU - Karlsson, K
AU - Stockelberg, D
AU - Wahlin, A
AU - Astrom, M
AU - Arnesson, C
AU - Brunell-Abrahamsson, U
AU - Carstensen, J
AU - Fredriksson, E
AU - Holmberg, E
AU - Nordenskjold, K
AU - Wiklund, F
PY - 2006
Y1 - 2006
N2 - Combination chemotherapy may induce remission from acute myeloid leukemia (AML), but validated criteria for treatment of elderly are lacking. The remission intention ( RI) rate for elderly patients, as reported to the Swedish Leukemia Registry, was known to be different when comparing the six health care regions, but the consequences of different management are unknown. The Leukemia Registry, containing 1672 AML patients diagnosed between 1997 and 2001, with 98% coverage and a median follow-up of 4 years, was completed with data from the compulsory cancer and population registries. Among 506 treated and untreated patients aged 70-79 years with AML (non-APL), there was a direct correlation between the RI rate in each health region ( range 36-76%) and the two-year overall survival, with no censored observations (6-21%) ( v 2 for trend = 11.3, P < 0.001; r(2) = 0.86, P < 0.02, nonparametric). A 1-month landmark analysis showed significantly better survival in regions with higher RI rates ( P = 0.003). Differences could not be explained by demographics, and was found in both de novo and secondary leukemias. The 5-year survival of the overall population aged 70-79 years was similar between the regions. Survival of 70-79-year-old AML patients is better in regions where more elderly patients are judged eligible for remission induction.
AB - Combination chemotherapy may induce remission from acute myeloid leukemia (AML), but validated criteria for treatment of elderly are lacking. The remission intention ( RI) rate for elderly patients, as reported to the Swedish Leukemia Registry, was known to be different when comparing the six health care regions, but the consequences of different management are unknown. The Leukemia Registry, containing 1672 AML patients diagnosed between 1997 and 2001, with 98% coverage and a median follow-up of 4 years, was completed with data from the compulsory cancer and population registries. Among 506 treated and untreated patients aged 70-79 years with AML (non-APL), there was a direct correlation between the RI rate in each health region ( range 36-76%) and the two-year overall survival, with no censored observations (6-21%) ( v 2 for trend = 11.3, P < 0.001; r(2) = 0.86, P < 0.02, nonparametric). A 1-month landmark analysis showed significantly better survival in regions with higher RI rates ( P = 0.003). Differences could not be explained by demographics, and was found in both de novo and secondary leukemias. The 5-year survival of the overall population aged 70-79 years was similar between the regions. Survival of 70-79-year-old AML patients is better in regions where more elderly patients are judged eligible for remission induction.
KW - acute myeloid leukemia
KW - elderly
KW - remission induction
KW - population based
KW - palliation
U2 - 10.1038/sj.leu.2404004
DO - 10.1038/sj.leu.2404004
M3 - Article
SN - 1476-5551
VL - 20
SP - 42
EP - 47
JO - Leukemia
JF - Leukemia
IS - 1
ER -