Frontline treatment patterns and outcomes among older adults with acute myeloid leukemia: A population‐based analysis in the modern era

Background Traditionally, conventional induction chemotherapy has been the primary frontline treatment for acute myeloid leukemia (AML); however, older adults are often poor chemotherapy candidates. Recently, several nonconventional frontline AML regimens, including hypomethylating agents, the BCL‐2 inhibitor venetoclax, and targeted therapies, have emerged, and they may offer new options for older adults. This study was aimed at describing treatment patterns and outcomes of older adult AML in a modern population‐based cohort. Methods This study evaluated patients aged ≥60 years with a first primary diagnosis of AML (2014‐2017) in the California Cancer Registry linked to inpatient hospitalizations. Multivariable regression examined factors associated with the frontline treatment regimen and survival. Results In all, 3068 patients were included; 36% received frontline therapy with a conventional chemotherapy backbone, 42% received nonconventional therapy, and 22% received no treatment. The use of nonconventional therapy increased over time from 38% of patients in 2014 to 47% in 2017 (P < .001). In multivariable analyses, receipt of treatment was associated with an age younger than 80 years, fewer than 2 comorbidities, and care at a National Cancer Institute–designated cancer center (NCI‐CC). Compared with conventional chemotherapy, nonconventional therapy was associated with Black race/ethnicity, public health insurance, fewer hospital admissions, and fewer inpatient days. Receiving frontline therapy at an NCI‐CC was independently associated with superior overall survival. Conclusions Using a population‐based approach, this study has demonstrated that patterns of care for frontline AML treatment in older adults are changing, with increasing use of nonconventional therapies. A significant proportion of older adults remain untreated. At the population level, there remain opportunities to increase therapy access for older adults with AML. Using a population‐based approach, this study demonstrates that frontline treatment patterns for older adults with acute myeloid leukemia are changing, with an increasing proportion of patients receiving treatment with newer, nontraditional agents. Despite these changes, a significant proportion of older adults with acute myeloid leukemia remain untreated, with the receipt of treatment associated with the location of frontline care.