Treatment patterns and survival outcomes for very elderly patients with acute myeloid leukemia: A National Cancer Database study.

Patients 80 years and older with acute myeloid leukemia (AML) are often not candidates for curative-intent treatments, and there is no standard algorithm for leukemia-directed management in this population. There is limited information on their treatment outcomes, especially since the availability of novel targeted options. We used the National Cancer Database to estimate overall survival for 31,195 patients diagnosed with AML at age 80 years and older between 2004 and 2021 and compared survival over time and across available treatment and sociodemographic variables. Median overall survival (mOS) was 1.71 months (95 % confidence interval [CI]: 1.68-1.74 months) and significantly longer in patients 80-84 years old compared to those 85 years and older (2.17 months, 95 % CI: 2.07-2.23 vs. 1.31 months, 95 % CI: 1.28-1.38; p < 0.01). mOS for those treated with multi-agent chemotherapy (MAC) was longer than those treated with single-agent regimens (5.95 months, 95 % CI: 5.52-6.34 vs. 3.38 months, 95 % CI: 3.22-3.52; p < 0.01). The proportion of patients receiving chemotherapy increased from 35 % in 2004-2008 to 56 % in 2019-2021 (p < 0.01) and use of multi-agent treatments increased from 26 % in 2004-2008 to 53 % in 2019-2021 (p < 0.01). In summary, significant gains in mOS were noted in 2019-2021, along with increased use of MAC, possibly due to the introduction of novel therapies such as venetoclax. Future work will focus on understanding complex treatment decisions for very elderly patients and the effect of contemporary MAC options such as hypomethylating agents and venetoclax on treatment patterns and survival.