Age and acute myeloid leukemia. Real world data on decision to treat and outcomes from the Swedish Acute Leukemia Registry.

In English AML is most common in elderly, and most elderly are believed to be unfit for intensive treatment due to the risk of fatal toxicity. The Swedish Acute Leukemia Registry covers 98% of all patients with AML (non-APL) diagnosed 1997-2005 (n=2767), with a median follow-up of 5 years, and reports eligibility for intensive therapy, performance status (PS), complete remission (CR) rates, and survival. Outcomes were strongly age and PS dependent. Early death rates were always lower with intensive therapy than with palliation only. Long-term survivors were found among elderly given intensive treatment despite poor initial PS. Total survival of elderly AML patients was better in the geographic regions where most of them were given standard intensive therapy. This analysis provides unique real world data from a large, complete and unselected AML population, both treated and untreated, and gives background to treatment decisions for the elderly. Standard intensive treatment improves early death rates and long-term survival as compared to palliation, most AML patients up to 80 years should be considered fit for intensive therapy, and new therapies must be compared with standard induction.