Contemporary Clinical Outcomes and Healthcare Utilization in Older Adults with Acute Myeloid Leukemia: Insights from a Single-Center Retrospective Cohort.

BACKGROUND

Acute myeloid leukemia (AML) predominantly affects older adults; however, patients 75 years of age and older are often not candidates for curative-intent treatments. Data on their treatment patterns, survival outcomes, and healthcare utilization are limited, and we evaluated these outcomes among patients 75 years of age and older with AML.

METHODS

We retrospectively analyzed 97 patients aged 75 years and older managed at our academic safety-net hospital between 2016 and 2025.

RESULTS

Median overall survival (mOS) was 95 days for all patients. Receipt of any AML-directed therapy was associated with longer mOS compared with no leukemia-directed treatment (144 days, 95% CI: 98-184 vs. 17 days, 95% CI: 7-50; p < 0.001). Among patients with 2024 ELN adverse-risk/TP53-mutated disease, mOS was 88 days (95% CI: 34-NE) with AML-directed therapy and 44 days (CI: 36-NE) without treatment (p = 0.2). Forty-four percent of patients were enrolled in a hospice at their time of death, and an additional 40% were managed with comfort measures as inpatients. Median duration of hospice or comfort care was 2 days (IQR: 1-5), with no difference based on whether patients received any AML-directed treatment. Fifty-one percent of patients died in the hospital.

CONCLUSIONS

Our findings highlight real-world challenges for older adults with AML, including the need for more effective treatments for patients with TP53-mutated AML. AML-directed treatment was associated with longer survival without a decrease in the time spent in hospice care, and the risk of in-hospital mortality remains elevated for this population.