ALBERT

Description: Introduction: The incidence of acute myeloid leukemia (AML) increases with age, however treatment efficacy and tolerability in older patients are poor compared to younger patients. Without treatment, patients succumb to their illness within a few months of diagnosis. Further, disease relapse is inevitable in the majority of cases without additional post-remission therapy after successful induction of remission. The use of allogeneic hematopoietic stem cell transplantation (HSCT) is considered a potential cure for AML but its use is limited in older patients because of significant comorbidities and increased transplant-related morbidity and mortality. This retrospective study assessed outcomes of older AML patients treated with chemotherapy with or without HSCT. Methods: The linked Surveillance, Epidemiology, and End Results (SEER)-Medicare database, was utilized in this retrospective cohort analysis of 3327 first primary AML patients. Patients were diagnosed between January 1, 2000 to December 31, 2009, were 〉66 years, continuously enrolled in Medicare Part A and B with no HMO coverage in the year prior to diagnosis and received treatment with chemotherapy with or without HSCT. Chi-square test for categorical variables and ANOVA or t-test for continuous variables was used to compare patient characteristics between treated patients with and without HSCT. Kaplan-Meier curves and Cox proportional hazards regression assessed overall survival. Date of last follow-up was December 31, 2010. Results: There were 276 (8%) patients who underwent HSCT therapy and 3051 (92%) who did not. HSCT patients were younger at diagnosis with mean age of 73 compared to the non-HSCT group (75 years; p75 years (n=1470) HR 95% CI HR 95% CI HR 95% CI No ref ref ref Yes 0.80 0.69-0.92 0.63 0.53-0.75 1.22 0.97-1.54 Disclosures Satram-Hoang: Genentech, Inc.: Consultancy. Hurst:Genentech, Inc.: Employment. Reyes:Genentech, Inc.: Employment.

Description: Introduction: A disproportionate number of newly diagnosed acute myeloid leukemia (AML) occurs in elderly patients. Conventional chemotherapy treatments for AML may be highly toxic and elderly patients often have increased comorbidity burden and loss of organ reserve that may impact their ability to tolerate therapy. Consequently, fewer than half of elderly patients with AML receive anti-leukemic therapy and outcomes among these patients have not improved in the last few decades. We described treatment patterns and outcomes of elderly AML patients in a real-world population. Methods: We utilized a retrospective cohort analysis of first primary AML patients in the linked Surveillance, Epidemiology, and End Results (SEER)-Medicare database. Patients were diagnosed between January 1, 2000 to December 31, 2009, 〉66 years, and continuously enrolled in Medicare Part A and B in the year prior to diagnosis. There were 8336 patients identified, of which 5009 (60%) did not receive treatment (NT). Chemotherapy agent definition was not possible in approximately 70% of patients who received therapy because chemotherapy was administered during inpatient stays which are paid based on ICD-9 diagnosis or procedures codes only and not chemotherapy codes. Of those initiating treatment within 3 months after diagnosis, 345 were treated with azacitidine + decitabine (AD) and 124 were treated with cytarabine+anthracycline (CA). Statistical comparisons were made between NT, AD and CA. To compare demographic and clinical characteristics by treatment, the Chi-square test for categorical variables and ANOVA or t-test for continuous variables was used. Kaplan-Meier curves and corresponding log-rank test were used to compare overall survival by treatment. Cox regression and propensity-weighted analyses estimated the relative risk of death adjusting for demographic and clinical factors. The date of last follow-up was December 31, 2010. Results: Patients receiving CA were younger (mean age 73 vs. 78 and 81), more likely male (62% vs. 59% and 50%), married (71% vs. 61% and 47%), had less secondary AML (7% vs. 21% and 19% with prior myelodysplastic syndrome [MDS]), less likely to have poor performance indicators (2% vs. 9% and 17%) and had lower comorbidity score compared to those receiving AD and NT, respectively. Similarities in age, comorbidity burden and proportion with high risk disease were noted in AD and NT patients. The median unadjusted overall survival was longer for patients treated with CA (18.9 months) compared to AD (6.6 months) and NT (1.7 months; log rank p 75) cohorts. Increasing age, increasing comorbidity score and presence of poor performance indicators were associated with significant increases in mortality. Propensity score adjusted multivariate analysis demonstrated similar risk reductions for CA (HR=0.41; 95% CI=0.34-0.49) and AD (HR=0.49; 95% CI=0.44-0.55). Conclusions: A substantial proportion of elderly AML patients are not receiving therapy for their disease. We observed a significant survival benefit with receiving treatment, even among the AD group who had similar characteristics to the NT group. Further, improved survival after receiving CA compared to AD was noted, but the propensity score adjusted analysis demonstrated similar reductions in death. The findings from this study can provide an important baseline for evaluating the benefits of new treatments under investigation. Table 1 Multivariate Overall Survival Analysis Covariates* n HR 95% CI Treatment Not Treated 5009 ref AD 345 0.47 0.42-0.53 CA 124 0.31 0.25-0.39 Age 66-70 537 ref 71-75 920 1.31 1.17-1.46 76-80 1276 1.42 1.27-1.58 〉80 2745 1.68 1.52-1.86 Poor Performance Indicators No 4605 ref Yes 873 1.30 1.20-1.41 *Model also includes sex, race, comorbidity score, prior MDS, marital status, and geographic region Disclosures Satram-Hoang: Genentech, Inc.: Consultancy. Hurst:Genentech, Inc.: Employment. Reyes:Genentech, Inc.: Employment.

Description: Introduction: Acute myeloid leukemia (AML) is the most common acute leukemia in adults with a median age at diagnosis of 66 years. Over half of the patients are diagnosed at age 65 or older and have shown no improvement in outcomes compared to younger patients in last few decades. The goal of the study was to examine the patient characteristics associated with receiving treatment and the survival outcomes in an older population in routine clinical practice. Methods: This retrospective cohort analysis utilized data from the linked Surveillance, Epidemiology, and End Results (SEER)-Medicare database. The database is a nationally representative collection of Medicare patients in 18 population-based SEER cancer registries from diverse geographic areas representative of about 26% of the United States population. The analysis included 8336 first primary AML patients diagnosed between January 1, 2000 to December 31, 2009, 〉66 years, and continuously enrolled in Medicare Part A and B with no HMO coverage in the year prior to diagnosis. Chi-square test for categorical variables and ANOVA or t-test for continuous variables was used to assess differences in patient and disease related characteristics by treatment status. Kaplan-Meier curves and Cox proportional hazards regression assessed survival by treatment status adjusting for age, sex, race, prior myelodysplastic syndrome (MDS), poor performance indicators (PPI), comorbidity, income, education, marital status, year of diagnosis and geographic region. Logistic regression modelling assessed patient characteristics predictive of not receiving treatment. Results: There were 3327 (40%) patients who received treatment with chemotherapy within 3 months of diagnosis and 5009 (60%) patients who did not receive treatment. Treatment rates increased over the study time-period from 35% in the year 2000 to 50% in 2009 (p