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Ito T, Sanford D, Tomuleasa C, Hsiao HH, Olivera LJE, Enjeti AK, Conca AG, Del Castillo TB, Girshova L, Martelli MP, Guvenc B, Bui CN, Delgado A, Duan Y, Guijarro BG, Llamas C, Lee JH. Healthcare resource utilization trends in patients with acute myeloid leukemia ineligible for intensive chemotherapy receiving first-line systemic treatment or best supportive care: A multicenter international study. Eur J Haematol 2022; 109:58-68. [PMID: 35298049 PMCID: PMC9324937 DOI: 10.1111/ejh.13769] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 03/10/2022] [Accepted: 03/14/2022] [Indexed: 12/12/2022]
Abstract
Objectives This retrospective chart review examined real‐world healthcare resource utilization (HRU) in patients with AML ineligible for intensive therapy who received first‐line systemic therapy or best supportive care (BSC). Methods Data were collected anonymously on patients with AML who initiated first‐line hypomethylating agents (HMA), low‐dose cytarabine (LDAC), other systemic therapy, or BSC. HRU endpoints included hospitalizations, outpatient consultations, transfusions, and supportive care. Results Of 1762 patients included, 46% received HMA, 11% received LDAC, 17% received other systemic therapy, 26% received BSC; median treatment durations were 118, 35, 33, and 57 days, respectively. Most patients were hospitalized, most commonly for treatment administration, transfusion, or infection (HMA 82%, LDAC 93%, other systemic therapy 83%, BSC 83%). A median number of hospitalizations were 2–6 across systemic groups and two for BSC, with median durations of 8–18 days. Transfusion rates and outpatient consultations were highest for HMA (80% and 79%) versus LDAC (57% and 53%), other systemic therapy (57% and 63%), and BSC (71% and 66%). Antivirals/antibiotics and antifungals were used more frequently than growth factors (72–92%, 34–63%, and 7–27%, respectively). Conclusion Patients with AML ineligible for intensive therapy have high HRU; novel therapies are needed to alleviate this burden.
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Affiliation(s)
- Tomoki Ito
- First Department of Internal Medicine, Kansai Medical University, Hirakata, Osaka, Japan
| | - David Sanford
- Leukemia/Bone Marrow Transplant Program of BC, Division of Hematology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ciprian Tomuleasa
- Department of Hematology, Ion Chiricuta Clinical Cancer Center, Cluj-Napoca, Romania
| | - Hui-Hua Hsiao
- Division of Hematology and Oncology, Department of Internal Medicine, Kaohsiung Medical University Hospital and Kaohsiung Medical University, Kaohsiung, Taiwan
| | | | - Anoop Kumar Enjeti
- Calvary Mater Newcastle, University of Newcastle, Waratah, New South Wales, Australia.,NSW Health Pathology, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | | | | | - Larisa Girshova
- Federal State Budgetary Institution "Almazov National Medical Research Centre" of the Ministry of Health of the Russian Federation, St Petersburg, Russia
| | - Maria Paola Martelli
- Department of Medicine and Surgery - Section of Hematology and Clinical Immunology, Santa Maria della Misericordia" Hospital, Perugia University, Perugia, Italy
| | - Birol Guvenc
- Department of Hematology, Cukurova University, Adana, Turkey
| | - Cat N Bui
- AbbVie, Inc., North Chicago, Illinois, USA
| | | | | | | | | | - Je-Hwan Lee
- Department of Hematology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Yoshida C, Kondo T, Ito T, Kizaki M, Yamamoto K, Miyamoto T, Morita Y, Eto T, Katsuoka Y, Takezako N, Uoshima N, Imada K, Ando J, Komeno T, Mori A, Ishikawa Y, Satake A, Watanabe J, Kawakami Y, Morita T, Taneike I, Nakayama M, Duan Y, Garbayo Guijarro B, Delgado A, Llamas C, Kiyoi H. Real-world treatment patterns and clinical outcomes in patients with AML in Japan who were ineligible for first-line intensive chemotherapy. Int J Hematol 2022; 116:89-101. [PMID: 35394258 DOI: 10.1007/s12185-022-03334-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 03/15/2022] [Accepted: 03/15/2022] [Indexed: 10/18/2022]
Abstract
Acute myeloid leukemia (AML) predominantly affects elderly adults, and its prognosis worsens with age. Treatment options for patients in Japan ineligible for intensive chemotherapy include cytarabine/aclarubicin ± granulocyte colony-stimulating factor (CA ± G), azacitidine (AZA), low-dose cytarabine (LDAC), targeted therapy, and best supportive care (BSC). The country's aging population and the evolving treatment landscape are contributing to a need to understand treatment pathways and associated outcomes. This retrospective chart review evaluated outcomes in patients across Japan with primary/secondary AML who were ineligible for intensive chemotherapy and began first-line treatment or BSC between 01/01/2015 and 12/31/2018. The primary endpoint was overall survival (OS); secondary endpoints included progression-free survival (PFS) and healthcare resource utilization (HRU). Of 199 patients (58% > 75 years), 121 received systemic therapy (38 CA ± G, 37 AZA, 7 LDAC, 39 other) and 78 received BSC. Median OS was 5.4, 9.2, 2.2, 3.8, and 2.2 months for CA ± G, AZA, LDAC, other systemic therapy, and BSC, respectively; median PFS was 3.4, 7.7, 1.6, 2.3, and 2.1 months, respectively. HRU rates were uniformly high, with > 80% patients hospitalized in each cohort. The poor clinical outcomes and high HRU among Japanese AML patients who are ineligible for intensive chemotherapy highlight an unmet need for novel therapies.
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Affiliation(s)
- Chikashi Yoshida
- Department of Hematology, National Hospital Organization Mito Medical Center, Ibaraki-machi, Japan.
| | - Takeshi Kondo
- Blood Disorders Center, Aiiku Hospital, Sapporo, Japan
| | - Tomoki Ito
- First Department of Internal Medicine, Kansai Medical University, Osaka, Japan
| | - Masahiro Kizaki
- Department of Hematology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | | | - Toshihiro Miyamoto
- Medicine and Biosystemic Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yasuyoshi Morita
- Division of Hematology and Rheumatology, Department of Internal Medicine, Kindai University, Osaka, Japan
| | - Tetsuya Eto
- Department of Hematology, Hamanomachi Hospital, Fukuoka, Japan
| | - Yuna Katsuoka
- Department of Hematology, Sendai Medical Center, National Hospital Organization, Sendai, Japan
| | - Naoki Takezako
- Department of Hematology, Disaster Medical Center, Tokyo, Japan
| | - Nobuhiko Uoshima
- Department of Hematology, Kyoto Second Red Cross Hospital, Kyoto, Japan
| | - Kazunori Imada
- Department of Hematology, Japanese Red Cross Osaka Hospital, Osaka, Japan
| | - Jun Ando
- Department of Hematology, Juntendo University School of Medicine, Tokyo, Japan
| | - Takuya Komeno
- Department of Hematology, National Hospital Organization Mito Medical Center, Ibaraki-machi, Japan
| | - Akio Mori
- Blood Disorders Center, Aiiku Hospital, Sapporo, Japan
| | - Yuichi Ishikawa
- Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Atsushi Satake
- First Department of Internal Medicine, Kansai Medical University, Osaka, Japan
| | - Junichi Watanabe
- Department of Hematology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | | | | | | | | | | | | | | | | | - Hitoshi Kiyoi
- Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Miyamoto T, Sanford D, Tomuleasa C, Hsiao HH, Olivera LJE, Enjeti AK, Gimenez Conca A, Castillo TBD, Girshova L, Martelli MP, Guvenc B, Delgado A, Duan Y, Garbayo Guijarro B, Llamas C, Lee JH. Real-world treatment patterns and clinical outcomes in patients with AML unfit for first-line intensive chemotherapy . Leuk Lymphoma 2022; 63:928-938. [PMID: 35147482 DOI: 10.1080/10428194.2021.2002321] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Acute myeloid leukemia (AML) predominantly affects the elderly, and prognosis declines with age. Induction chemotherapy plus consolidation therapy is standard of care for fit patients; options for unfit patients include hypomethylating agents (HMA), low-dose cytarabine (LDAC), targeted therapies, and best supportive care (BSC). This retrospective chart review evaluated clinical outcomes in unfit patients with AML who initiated first-line treatment or BSC 01/01/2015-12/31/2018. Overall survival (OS), progression-free survival (PFS), time-to-treatment failure (TTF), and response rates were assessed. Of 1762 patients, 1310 received systemic therapies: 809 HMA, 199 LDAC, and 302 other therapies; 452 received BSC. Median OS was 9.9, 7.9, 5.4, and 2.5 months for HMA, LDAC, other, and BSC, respectively. Median PFS was 7.5, 5.3, 4.1, and 2.1 months for HMA, LDAC, other, and BSC, respectively; median TTF was 4.9, 2.1, 2.2, and 2.1 months, respectively. Our findings highlight the unmet need for novel therapies for unfit patients.
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Affiliation(s)
- Toshihiro Miyamoto
- Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - David Sanford
- Division of Hematology, Leukemia/Bone Marrow Transplant Program of BC, The University of British Columbia, Vancouver, BC, Canada
| | - Ciprian Tomuleasa
- Department of Hematology - Medfuture Research Center for Advanced Medicine, Ion Chiricuta Clinical Cancer Center, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Hui-Hua Hsiao
- Department of Internal Medicine, Division of Hematology-Oncology, Kaohsiung Medical University Hospital and Kaohsiung Medical University, Kaohsiung, Taiwan
| | | | - Anoop Kumar Enjeti
- Calvary Mater Newcastle, University of Newcastle and New South Wales Health Pathology, Waratah, Australia
| | | | - Teresa Bernal Del Castillo
- Servicio de Hematología y Hemoterapia, University Hospital Central de Asturias, ISPA, IUOPA, Oviedo, Spain
| | - Larisa Girshova
- Federal State Budgetary Institution 'Almazov National Medical Research Centre' of the Ministry of Health of the Russian Federation, St. Petersburg, Russia
| | - Maria Paola Martelli
- Department of Medicine and Surgery - Section of Hematology and Clinical Immunology, Perugia University, 'Santa Maria della Misericordia' Hospital, Perugia, Italy
| | - Birol Guvenc
- Department of Hematology, Faculty of Medicine, Cukurova University, Adana, Turkey
| | | | | | | | | | - Je-Hwan Lee
- Department of Hematology, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Republic of Korea
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