Usefulness of Charlson Comorbidity Index to Predict Early Mortality and Overall Survival in Older Patients With Acute Myeloid Leukemia |
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| Affiliation: | 1. Division of Oncology and Hematology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE;2. Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE;3. Department of Biostatics, College of Public Health, University of Nebraska Medical Center, Omaha, NE;1. Department of Hematology and Oncology, Emory University School of Medicine, Atlanta, GA;2. Department of Leukemia, Division of Cancer Medicine, The University of Texas M.D. Anderson Cancer Center, Houston, TX;3. Department of Clinical Development, Gemin X Pharmaceuticals, Malvern, PA;4. Department of Medical Affairs, Powered 4 Significance LLC, Annandale, NJ;5. Division of Hematology/Oncology, Columbia University Medical Center, New York, NY;1. Department of Medicine, Division of Hematology/Oncology, Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA;2. Department of Medicine, Division of Hematology/Oncology, University of California Davis Comprehensive Cancer Center, Sacramento, CA;3. Department of Medicine, Division of Hematology/Oncology, Moores Cancer Center, University of California, San Diego, La Jolla, CA;4. Atara Biotherapeutics Inc, Thousand Oaks, CA;5. Gilead Sciences, Daly City, CA;1. Medical Laboratory Sciences Department, Health Sciences Center, Kuwait University, Kuwait;2. Department of Medicine, Health Sciences Center, Kuwait University, Kuwait;3. Baylor University Medical Center, TX, USA;1. King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia;2. Moffitt Cancer Center, Tampa, FL;1. Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX, USA;2. Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX, USA;3. Department of Hematopathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA;4. Division of Hematology/Oncology, Chao Family Comprehensive Cancer Center, University of California, Irvine, Orange, CA, USA;1. Division of Hematology-Oncology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE;2. Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE;3. Department of Biostatistics, University of Nebraska Medical Center, College of Public Health, Omaha, NE;4. College of Nursing, University of Nebraska Medical Center, Omaha, NE |
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| Abstract: | IntroductionOlder adults with acute myeloid leukemia (AML) often have significant comorbidities. We hypothesized that greater comorbidity burden predicts worse 1-month mortality and overall survival (OS) in patients ≥60 years with AML.Materials and methodsWe included 50,668 patients ≥60 years diagnosed between 2004 and 2014 from the National Cancer Database; patients were divided into 3 groups with Charlson comorbidity index (CCI) 0, 1, and ≥2. Chi-square tests were used to examine the association between CCI and different variables. We used logistic regression and Cox proportional hazard models to determine predictors of 1-month mortality and OS, respectively.ResultsAmong the entire cohort, 65% had CCI 0, 24% had CCI 1, and 11% had CCI ≥2. Thirty-four percent did not receive chemotherapy. Patients with CCI 0 were more likely to receive chemotherapy, especially multiagent chemotherapy and undergo upfront hematopoietic cell transplantation. In multivariate analyses, 1-month mortality and OS were significantly worse with CCI 1 or ≥2, compared with CCI 0 in the entire cohort, as the subgroup of only those patients who received chemotherapy. Younger age, male gender, higher annual income, academic facility, longer travel distance, and acute promyelocytic leukemia were associated with improved OS.ConclusionIn one of the largest real-world studies of older adults with AML, we demonstrated that greater comorbidity, measured by higher CCI, independently predicted worse early mortality and OS in older patients with AML. Higher CCI was more common with increasing age and correlated with lower likelihood of receiving chemotherapy and hematopoietic cell transplantation. Whether optimal comorbidity management and supportive care may improve outcomes needs to be studied further. |
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| Keywords: | Acute leukemia Chemotherapy Geriatrics Older adults Survival |
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