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Jensen-Battaglia M, LoCastro M, Oh H, Sanapala C, Flannery M, Mendler JH, Liesveld J, Huselton E, Loh KP. Patient-oncologist discussion of treatment decisions: Exploring the role of a patient-centered communication tool for older adults with acute myeloid leukemia and their caregivers. J Geriatr Oncol 2024; 15:101716. [PMID: 38336521 DOI: 10.1016/j.jgo.2024.101716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 01/12/2024] [Accepted: 01/25/2024] [Indexed: 02/12/2024]
Affiliation(s)
- Marielle Jensen-Battaglia
- James P. Wilmot Cancer Institute and Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA.
| | - Marissa LoCastro
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
| | - Haejung Oh
- The Catholic University of Korea, School of Medicine, Seoul, South Korea
| | | | - Marie Flannery
- School of Nursing, University of Rochester Medical Center, Rochester, NY, USA.
| | - Jason H Mendler
- Division of Hematology/Oncology, Department of Medicine, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA.
| | - Jane Liesveld
- Division of Hematology/Oncology, Department of Medicine, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA.
| | - Eric Huselton
- Division of Hematology/Oncology, Department of Medicine, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA.
| | - Kah Poh Loh
- Division of Hematology/Oncology, Department of Medicine, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA.
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2
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Muffly L, Young C, Feng Q, Nimke D, Pandya BJ. Healthcare resource utilization and costs during first salvage therapy for relapsed or refractory acute myeloid leukemia in the United States. Leuk Lymphoma 2023; 64:1832-1839. [PMID: 37486091 DOI: 10.1080/10428194.2023.2235044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 06/30/2023] [Accepted: 07/05/2023] [Indexed: 07/25/2023]
Abstract
Real-world US healthcare resource utilization (HRU) and costs during first salvage therapy for relapsed/refractory (R/R) acute myeloid leukemia (AML) are described using IBM MarketScan® data (1/1/2007-6/30/2020). Treatments included high- (HIC) and low-intensity chemotherapy (LIC) alone, and gilteritinib, other FLT3 tyrosine kinase inhibitors (TKIs), and venetoclax with or without chemotherapy. Patients were diagnosed with R/R AML at ≥18 years of age between 1/1/2017-12/31/2019. Patient monthly all-cause HRU and costs were analyzed using a fixed-effects model. Data from 399 patients were analyzed (HIC, n = 104; LIC, n = 133; gilteritinib, n = 14; other FLT3 TKIs, n = 68; venetoclax, n = 80). Inpatient HRU was generally highest with HIC, whereas outpatient HRU was generally highest with LIC and venetoclax. Total all-cause incremental monthly costs appeared to be highest with HIC ($171,982) and similar for LIC ($60,512), gilteritinib ($47,218), other FLT3 TKIs ($43,218), and venetoclax ($77,566). Results highlight HRU and cost differences for R/R AML during first salvage therapy.
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Affiliation(s)
- Lori Muffly
- Division of Blood and Marrow Transplantation and Cellular Therapy, Stanford University, Stanford, CA, USA
| | | | - Qi Feng
- Astellas Pharma, Inc, Northbrook, IL, USA
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Senjo H, Onozawa M, Hidaka D, Yokoyama S, Yamamoto S, Tsutsumi Y, Haseyama Y, Nagashima T, Mori A, Ota S, Sakai H, Ishihara T, Miyagishima T, Kakinoki Y, Kurosawa M, Kobayashi H, Iwasaki H, Hashimoto D, Kondo T, Teshima T. High CRP-albumin ratio predicts poor prognosis in transplant ineligible elderly patients with newly diagnosed acute myeloid leukemia. Sci Rep 2022; 12:8885. [PMID: 35614177 PMCID: PMC9133033 DOI: 10.1038/s41598-022-12813-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 05/16/2022] [Indexed: 11/09/2022] Open
Abstract
Acute myeloid leukemia (AML) patients older than 65 years have a poor prognosis. Recently, CAR (C-reactive-protein/albumin ratio) has been actively reported as a prognostic index reflecting the nutritional and inflammatory status of elderly patients with solid tumors, but the usefulness of this index as a prognostic indicator in transplant-ineligible elderly AML patients has not been investigated. We studied genetic alterations and CARs in 188 newly diagnosed AML patients aged 65 years or older who were treated in a multicenter setting and had treated without HSCT. Both NCCN 2017 risk group, reflecting the genetic component of the tumor, and CAR, reflecting the inflammatory and nutritional status of the patient, successfully stratified the overall survival (OS) of the patients (2-year OS; CAR low vs high, 42.3% vs 17.8%, P < 0.001). Furthermore, in multivariate analysis, NCCN 2017 poor group and high CAR were extracted as independent poor prognostic factors predicting 2-year OS in the current study. We found, for the first time, that CAR at diagnosis predicted the prognosis of elderly patients with newly diagnosed AML treated without HSCT.
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Affiliation(s)
- Hajime Senjo
- Department of Hematology, Faculty of Medicine, Hokkaido University, N15 W7, Kita-ku, Sapporo, 060-8638, Japan.
| | - Masahiro Onozawa
- Department of Hematology, Faculty of Medicine, Hokkaido University, N15 W7, Kita-ku, Sapporo, 060-8638, Japan
| | - Daisuke Hidaka
- Department of Hematology, Sapporo Hokuyu Hospital, Sapporo, Japan
| | - Shota Yokoyama
- Department of Hematology, Faculty of Medicine, Hokkaido University, N15 W7, Kita-ku, Sapporo, 060-8638, Japan
| | - Satoshi Yamamoto
- Department of Hematology, Sapporo City General Hospital, Sapporo, Japan
| | - Yutaka Tsutsumi
- Department of Hematology, Hakodate Municipal Hospital, Hakodate, Japan
| | | | - Takahiro Nagashima
- Department of Hematology, Japanese Red Cross Kitami Hospital, Kitami, Japan
| | - Akio Mori
- Blood Disorders Center, Aiiku Hospital, Sapporo, Japan
| | - Shuichi Ota
- Department of Hematology, Sapporo Hokuyu Hospital, Sapporo, Japan
| | - Hajime Sakai
- Department of Hematology, Teine Keijinkai Hospital, Sapporo, Japan
| | | | | | | | | | - Hajime Kobayashi
- Department of Hematology, Obihiro Kosei General Hospital, Obihiro, Japan
| | - Hiroshi Iwasaki
- Department of Hematology, Sapporo Kosei General Hospital, Sapporo, Japan
| | - Daigo Hashimoto
- Department of Hematology, Faculty of Medicine, Hokkaido University, N15 W7, Kita-ku, Sapporo, 060-8638, Japan
| | - Takeshi Kondo
- Blood Disorders Center, Aiiku Hospital, Sapporo, Japan
| | - Takanori Teshima
- Department of Hematology, Faculty of Medicine, Hokkaido University, N15 W7, Kita-ku, Sapporo, 060-8638, Japan
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4
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Stubbins RJ, Stamenkovic M, Roy C, Rodrigo J, Chung S, Kuchenbauer FC, Hay KA, White J, Abou Mourad Y, Power MM, Narayanan S, Forrest DL, Toze CL, Sutherland HJ, Nantel SH, Nevill TJ, Karsan A, Song KW, Sanford DS. Incidence and socioeconomic factors in older adults with acute myeloid leukaemia: Real-world outcomes from a population-based cohort. Eur J Haematol Suppl 2022; 108:437-445. [PMID: 35122325 DOI: 10.1111/ejh.13752] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/31/2022] [Accepted: 02/02/2022] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Acute myeloid leukaemia (AML) is a disease of older adults, who are vulnerable to socio-economic factors. We determined AML incidence in older adults and the impact of socio-economic factors on outcomes. METHODS We included 3024 AML patients (1996-2016) identified from a population-based registry. RESULTS AML incidence in patients ≥60 years increased from 11.01 (2001-2005) to 12.76 (2011-2016) per 100 000 population. Among 879 patients ≥60 years in recent eras (2010-2016), rural residents (<100 000 population) were less likely to be assessed by a leukaemia specialist (39% rural, 47% urban, p = .032); no difference was seen for lower (43%, quintile 1-3) vs. higher (47%, quintile 4-5) incomes (p = .235). Similar numbers received induction chemotherapy between residence (16% rural, 18% urban, p = .578) and incomes (17% lower, 17% high, p = 1.0). Differences between incomes were seen for hypomethylating agent treatment (14% low, 20% high, p = .041); this was not seen for residence (13% rural, 18% urban, p = .092). Among non-adverse karyotype patients ≥70 years, 2-year overall survival was worse for rural (5% rural, 12% urban, p = .006) and lower income (6% low, 15% high, p = .017) patients. CONCLUSIONS AML incidence in older adults is increasing, and outcomes are worse for older rural and low-income residents; these patients face treatment barriers.
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Affiliation(s)
- Ryan J Stubbins
- Leukaemia/BMT Program of BC, BC Cancer, Vancouver, British Columbia, Canada.,Division of Hematology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Canada's Michael Smith Genome Sciences Center, BC Cancer Research Center, Vancouver, British Columbia, Canada
| | - Maria Stamenkovic
- Division of Hematology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Claudie Roy
- Leukaemia/BMT Program of BC, BC Cancer, Vancouver, British Columbia, Canada.,Division of Hematology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Judith Rodrigo
- Leukaemia/BMT Program of BC, BC Cancer, Vancouver, British Columbia, Canada.,Division of Hematology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Shanee Chung
- Leukaemia/BMT Program of BC, BC Cancer, Vancouver, British Columbia, Canada.,Division of Hematology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Florian C Kuchenbauer
- Leukaemia/BMT Program of BC, BC Cancer, Vancouver, British Columbia, Canada.,Division of Hematology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Terry Fox Lab, BC Cancer Research Center, Vancouver, British Columbia, Canada
| | - Kevin A Hay
- Leukaemia/BMT Program of BC, BC Cancer, Vancouver, British Columbia, Canada.,Division of Hematology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Terry Fox Lab, BC Cancer Research Center, Vancouver, British Columbia, Canada
| | - Jennifer White
- Leukaemia/BMT Program of BC, BC Cancer, Vancouver, British Columbia, Canada.,Division of Hematology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Yasser Abou Mourad
- Leukaemia/BMT Program of BC, BC Cancer, Vancouver, British Columbia, Canada.,Division of Hematology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Maryse M Power
- Leukaemia/BMT Program of BC, BC Cancer, Vancouver, British Columbia, Canada.,Division of Hematology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sujaatha Narayanan
- Leukaemia/BMT Program of BC, BC Cancer, Vancouver, British Columbia, Canada.,Division of Hematology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Donna L Forrest
- Leukaemia/BMT Program of BC, BC Cancer, Vancouver, British Columbia, Canada.,Division of Hematology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Cynthia L Toze
- Leukaemia/BMT Program of BC, BC Cancer, Vancouver, British Columbia, Canada.,Division of Hematology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Heather J Sutherland
- Leukaemia/BMT Program of BC, BC Cancer, Vancouver, British Columbia, Canada.,Division of Hematology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Stephen H Nantel
- Leukaemia/BMT Program of BC, BC Cancer, Vancouver, British Columbia, Canada.,Division of Hematology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Thomas J Nevill
- Leukaemia/BMT Program of BC, BC Cancer, Vancouver, British Columbia, Canada.,Division of Hematology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Aly Karsan
- Leukaemia/BMT Program of BC, BC Cancer, Vancouver, British Columbia, Canada.,Division of Hematology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Canada's Michael Smith Genome Sciences Center, BC Cancer Research Center, Vancouver, British Columbia, Canada
| | - Kevin W Song
- Leukaemia/BMT Program of BC, BC Cancer, Vancouver, British Columbia, Canada.,Division of Hematology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - David S Sanford
- Leukaemia/BMT Program of BC, BC Cancer, Vancouver, British Columbia, Canada.,Division of Hematology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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5
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Ha H, Jeong Y, Lim JH, Suh YJ. Treatment Pattern, Financial Burden and Outcomes in Elderly Patients with Acute Myeloid Leukemia in Korea: A Nationwide Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042317. [PMID: 35206499 PMCID: PMC8872510 DOI: 10.3390/ijerph19042317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 02/11/2022] [Accepted: 02/12/2022] [Indexed: 12/10/2022]
Abstract
Although approximately 50% of patients with acute myeloid leukemia (AML) are diagnosed over the age of 60 years, there is currently no established consensus on the treatment of elderly AML patients. Herein, we aimed to explore the incidence, medical expenditure, treatment, and outcomes of elderly AML patients in Korea by analyzing a nationwide cohort. We employed the Korean National Health Insurance Service-Senior cohort, which represents 10% of a random selection from a total of 5.5 million subjects aged 60 years or older. AML patients were identified according to the main diagnostic criteria of acute leukemia. Treatment for AML was divided into high- (high-dose cytarabine ± idarubicin) and low- (low-dose cytarabine or hypomethylating agents) intensity chemo-therapy and classified according to the chemotherapeutics protocol. We analyzed the survival outcomes and medical expenditures. Among 558,147 elderly patients, 471 were diagnosed with AML, and 195 (41.4%) were treated with chemotherapy. The median age was 65 years, and the median overall survival (OS) was 4.93 months (95% confidence interval, 4.47–5.43). Median OS was longer in patients undergoing chemotherapy than those in the best supportive care group (6.28 vs. 3.45 months, p < 0.001), and the difference was prominent in patients aged < 70 years. Twenty-eight (5.9%) patients received high-intensity chemotherapy, while 146 (31.0%) received low-intensity chemotherapy. The difference in median OS according to dose intensity was 4.6 months, which was longer in the high-intensity chemotherapy group (9.8 vs. 5.2 months in low-intensity group); however, the difference was not statistically significant. Patients who received high-intensity chemotherapy recorded longer hospital stays and incurred greater expenses on initial hospitalization. Elderly AML patients in Korea exhibited clinical benefits from chemotherapy. Although patients should be carefully selected for intensive treatment, chemotherapy, including low-intensity treatment, can be considered in elderly patients. Moreover, prospective studies on new agents or new treatment strategies are needed.
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Affiliation(s)
- Hyerim Ha
- Department of Internal Medicine, Inha University Hospital, Incheon 22332, Korea;
| | - Yujin Jeong
- Department of Biostatistics, Korea University College of Medicine, Seoul 02841, Korea;
| | - Joo Han Lim
- Department of Internal Medicine, Inha University Hospital, Incheon 22332, Korea;
- Correspondence: (J.H.L.); (Y.J.S.); Tel.: +82-32-890-2581 (J.H.L.); +82-32-890-2833 (Y.J.S.)
| | - Young Ju Suh
- Department of Biomedical Sciences, College of Medicine, Inha University, Incheon 22332, Korea
- Correspondence: (J.H.L.); (Y.J.S.); Tel.: +82-32-890-2581 (J.H.L.); +82-32-890-2833 (Y.J.S.)
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