title: Age and acute myeloid leukemia: real world data on decision to treat and outcomes from the Swedish Acute Leukemia Registry.
abstract: Acute myeloid leukemia (AML) is most common in the elderly, and most elderly are thought to be unfit for intensive treatment because of the risk of fatal toxicity. The Swedish Acute Leukemia Registry covers 98% of all patients with AML (nonacute promyelocytic leukemia) diagnosed in 1997 to 2005 (n = 2767), with a median follow-up of 5 years, and reports eligibility for intensive therapy, performance status (PS), complete remission rates, and survival. Outcomes were strongly age and PS dependent. Early death rates were always lower with intensive therapy than with palliation only. Long-term survivors were found among elderly given intensive treatment despite poor initial PS. Total survival of elderly AML patients was better in the geographic regions where most of them were given standard intensive therapy. This analysis provides unique real world data from a large, complete, and unselected AML population, both treated and untreated, and gives background to treatment decisions for the elderly. Standard intensive treatment improves early death rates and long-term survival compared with palliation. Most AML patients up to 80 years of age should be considered fit for intensive therapy, and new therapies must be compared with standard induction.
authors.affiliation: Department of Hematology and Regional Tumor Registry, Lund University Hospital, Lund, Sweden. Gunnar.Juliusson@med.lu.se
authors.forename: Gunnar
authors.initials: G
authors.lastname: Juliusson
authors.forename: Petar
authors.initials: P
authors.lastname: Antunovic
authors.forename: Asa
authors.initials: A
authors.lastname: Derolf
authors.forename: Sören
authors.initials: S
authors.lastname: Lehmann
authors.forename: Lars
authors.initials: L
authors.lastname: Möllgård
authors.forename: Dick
authors.initials: D
authors.lastname: Stockelberg
authors.forename: Ulf
authors.initials: U
authors.lastname: Tidefelt
authors.forename: Anders
authors.initials: A
authors.lastname: Wahlin
authors.forename: Martin
authors.initials: M
authors.lastname: Höglund
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D015331:Cohort Studies; D003657:Decision Making; D005260:Female; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012042:Registries; D015996:Survival Rate; D013548:Sweden; D016896:Treatment Outcome; D055815:Young Adult