Results of a retrospective study of older patients with AML showed similar health care-related costs for those receiving either anthracycline-based induction chemotherapy (IC) followed by either consolidation chemotherapy or hematopoietic stem cell transplantation (HSCT), or hypomethylating agent monotherapy with azacitadine or decitabine (HMA). The findings of this study were published in Leukemia & Lymphoma. 

With a median age at diagnosis of 68 years in the United States, acute myeloid leukemia (AML) is primarily a disease of older people. Furthermore, more than two-thirds of patients are classified as having intermediate- or adverse-risk disease that is associated with poor outcomes.

While treatment options for older patients with AML include IC followed by consolidative chemotherapy or HSCT, hypomethylating agent monotherapy with azacitadine or decitabine (HMA), HMA plus targeted therapy, and low-dose Ara-C, there is no standard-of-care treatment approach, particularly for those who cannot tolerate IC. This study involved a comparison of health care outcomes, interventions and their associated costs for older patients receiving initial treatment with either IC or HMA.

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Electronic medical records of patients with AML receiving initial treatment between 2010 and 2016 were assessed for demographic, clinicopathologic, and treatment-related characteristics, inpatient and outpatient encounters, blood product transfusions received, as well as the charges associated with the health care encounters and treatments.

Of the 70 patients included in the analysis, 45 and 25 patients received initial treatment with IC and HMA, respectively. The median patient age was 69 years in the IC group and 73 years in the HMA group. In the IC group, 49% of patients received HSCT, whereas only 12% of patients in the HMA group underwent this procedure, with all patients in both groups in complete remission (CR) at the time of transplantation.  

There was no significant difference in median total health care encounters (47 vs 37; P =.25), median outpatient encounters (16 vs 19; P =.70), percentage of time in direct contact with the health care system (33.30% vs 19.70%; P =.19), median total charges ($261,751 vs $244,672; P =.184), median number of transfusions (18 vs 20; P =.56), and total transfusion charges ($29,850 vs $35,610; P =.51) between the IC and the HMA groups, respectively. However, patients in the IC group had a higher median number of inpatient encounters (32 vs 13; P <.001), resulting in higher inpatient charges compared with those in the HMA group.

Regarding patient outcomes, median overall survival (OS) was 439 days and 257 days for the IC and HMA groups, respectively (P =.001). For the subgroups of patients undergoing HSCT, median OS was 324 for those receiving HMA and 839 days for patients treated with IC.

“While a role exists for HMA therapy in the palliative treatment of older patients with AML, a considerable amount of hematologic toxicity occurs without marked improvement in OS,” the authors commented.

In summarizing the study findings, the authors concluded that “[these] data demonstrate that patients undergoing HMA or IC utilize a large amount of resources. Such observations better inform clinicians and patients regarding treatment expectations, approaches, impact on quality of life, and potentially timing of palliative care involvement. Future studies with larger cohorts are necessary to capture the scope of healthcare utilization amongst older patients with AML”.

Reference

Lachowiez CKearney MMeyers G, et al. Healthcare expenditures of older patients with AML are similar between HMA and intensive induction chemotherapy [published online May 4, 2019]. Leuk Lymphoma. 4. doi: 10.1080/10428194.2019.1605512