Approximately one-third of older patients admitted to an intensive care unit (ICU) during or following treatment for acute myeloid leukemia (AML) survive for 90 days following hospital discharge, results of a study published in Cancer have shown.1
Although the median overall survival (OS) for older patients (aged 60 years and older) with AML is short (6 to 8 months), a subpopulation of these patients can achieve long-term disease-free survival, particularly following treatment with intensive chemotherapy. However, such treatment in the overall population of patients with AML is associated with a high rate of complications, necessitating admission to an ICU for some patients.
In a previous study of patients with newly diagnosed AML who were undergoing treatment with intensive therapy and had a median age of approximately 53 years, 16.4% were admitted to the ICU; the survival rate to hospital discharge in this subgroup was 59.0%, and 41.3% of these patients were alive 1 year following hospital discharge.2 However, no comparable studies have been performed regarding ICU utilization, as well as clinical outcomes, and predictors of mortality for older patients with AML admitted to the ICU.
Continue Reading
This retrospective analysis included all older patients with a new diagnosis of AML at Dana-Farber Cancer Institute/Brigham and Women’s Hospital or Massachusetts General Hospital between May 1, 2005, and December 31, 2013, who were receiving or had received either intensive therapy (a standard or modified 7+3 regimen) or nonintensive therapy (low-dose cytarabine or single-agent therapy in a clinical trial). Only the first ICU admission was considered in this analysis.1
Selected baseline characteristics of the 330 patients included in the study were a median age of 69 years and a mean hematopoietic cell transplantation–specific comorbidity index (HCT-CI) of 1, with 59.7% currently or previously treated with intensive therapy.
In the overall study population, 29% (n=96) were admitted to the ICU; of this subgroup, 54.2% were receiving initial treatment, 8.3% were receiving consolidation therapy, 16.7% were in complete remission without currently receiving therapy, and 19.8% were receiving second- or third-line therapy. Admission to the ICU was fairly evenly divided between those admitted within 30 days of diagnosis (34.4%), within 30 to 180 days of diagnosis (30.2%), and more than 180 days following diagnosis of AML (27.1%).
The primary reasons for ICU admission were varied, and included respiratory failure (39%), septic shock (28%), neurologic complications (9%), cardiogenic shock/myocardial infarction/arrhythmia (7%), hematologic shock (7%), and other (9%).
A key finding of this study was that 47% (n=45) of those patients admitted to the ICU survived to be discharged from the hospital, with 35% (n=34) and 30% (n=29) alive 90 days and 1 year following hospital discharge, respectively. Importantly, in the subgroup of patients alive at 90 days following ICU admission, the mean Eastern Cooperative Oncology Group-Performance Status (ECOG-PS) score was 1.28 following ICU discharge, and 68% were independent with respect to activities of daily living at post-ICU assessment.
In contrast, a multivariate analysis of factors associated with in-hospital mortality included a higher preadmission ECOG-PS score (odds ratio [OR], 2.76; 95% CI,
1.24-6.12; P =.013), and a requirement for more than 1 life-sustaining therapy — invasive ventilation, vasopressors, and/or acute renal replacement therapy — while in the ICU (OR, 12.39; 95% CI, 3.10-49.48; P <.001).
The study authors opined that “these findings support the judicious use of ICU resources for older patients with AML, particularly those with a good performance status, and can better inform patient-clinician discussions regarding ICU outcomes in this population.”
References
- Slavin SD, Fenech A, Jankowski AL, et al. Outcomes for older adults with acute myeloid leukemia after an intensive care unit admission [published online July 12, 2019]. Cancer. doi: 10.1002/cncr.32397
- Jackson K, Mollee P, Morris K, et al. Outcomes and prognostic factors for patients with acute myeloid leukemia admitted to the intensive care unit. Leuk Lymphoma. 2014;55(1):97-104.
This article originally appeared on Oncology Nurse Advisor
