The Evolution of Treatment Policies and Outcomes for Patients Aged 60 and Older with Acute Myeloid Leukemia: A Population-Based Analysis over Two Decades

Background: Acute myeloid leukemia (AML) is a malignancy of the bone marrow with a median age at diagnosis of 70 years. AML is difficult to treat, especially in older patients, among whom outcomes have historically been poor. Over the last two decades, a greater understanding of the molecular mechanisms of the pathology has led to the development of new drugs and multiple updates to treatment guidelines. Methods: A population-based retrospective cohort study was conducted for all patients aged 60 and older who were newly diagnosed with AML (n = 370) as defined by the European Leukemia Net 2022 criteria in Friesland, a Dutch province, between 2005 and 2023. Results: In this cohort of patients with a median age of 73 years, complete bone marrow analysis to classify the AML according to ELN increased in time from 49% (2005–2011) to 86% (2022–2023). The rate of patients receiving antileukemic therapy increased over time (2005–2011: 19%; 2012–2016: 64%; 2017–2021: 75%; 2022–2023: 74%), mainly driven by the introduction of hypomethylating agents. Over these time periods, the use of intensive chemotherapy (13%, 27%, 27%, and 5%) and rates of stem cell transplantation (3%, 9%, 27%, and 14%) underwent similar development as more patients were deemed eligible for these interventions from 2012 onwards, but usage declined again after the introduction of venetoclax in 2022. The median overall survival was 3.7, 7.3, 8.0, and 9.4 months over the four time periods, respectively. Conclusions: Our study demonstrates how outcomes of patients with newly diagnosed AML aged 60 and older improved over the last two decades.