Trends in Five-Year Overall Survival Among Elderly Patients with Acute Myeloid Leukemia (AML) Between 2000-2009 and 2010-2019

Abstract

Acute myeloid leukaemia is a disease of older people, with a median age at diagnosis around 70, yet almost every therapeutic advance of the past two decades has been measured in populations younger than that. Population-level survival data show what reached the patients who actually have the disease. Objectives: To review the published evidence on how five-year and shorter-term survival in elderly acute myeloid leukaemia has changed across the 2000s and 2010s: what registry data show, which age bands gained, what the treatment changes were, and why the gains are smaller than the trial literature would suggest. Material and Methods: Narrative review of population-based registry analyses, randomised trials in older or unfit patients, and consensus recommendations indexed in PubMed and the major haematology journals. Studies were eligible if they reported survival by age band and calendar period in a defined acute myeloid leukaemia population, or the efficacy of a therapy studied specifically in older adults. No new patient data were generated and no patients were recruited; every estimate quoted is one published by the original investigators. Results: Across registry analyses spanning 2000 to 2022, five-year survival rose from 9.3 to 19.6 per cent in patients aged 65 to 74 and from 1.9 to 4.7 per cent in
those aged 75 and over, against a rise from 27.9 to 44.4 per cent in patients aged 40 to 64. Earlier analysis of roughly 19,000 patients aged 65 and above across three decades showed 12-month survival in the 65 to 74 group rising from 20 to 25 to 30 per cent, with no improvement at all above 75. In randomised comparison restricted to high-risk or secondary disease in 309 patients aged 60 to 75, a liposomal anthracycline-cytarabine formulation extended median overall survival from 5.95 to 9.56 months (HR 0.69, 95% CI 0.52-0.90). Registry work consistently shows that a large minority of older patients receive no antileukaemic therapy at all. Conclusion: Survival in elderly acute myeloid leukaemia improved materially between the two decades, but the absolute gain is 10 percentage points at 65 to 74 and under 3 above 75. Proportional doubling reads impressively and describes a five-year survival that remains below one in five. The largest single determinant at population level is whether the patient is treated at all. Abbreviations: AML – Acute Myeloid Leukaemia, HMA – Hypomethylating Agent, CR – Complete Remission, OS – Overall Survival, RS – Relative Survival,
SEER – Surveillance, Epidemiology and End Results, ELN – European LeukemiaNet, alloHCT – Allogeneic Haematopoietic Cell Transplantation, MRD – Measurable Residual Disease, HR – Hazard Ratio, CI – Confidence Interval.

Acute Myeloid Leukaemia; Elderly; Overall Survival; Hypomethylating Agents; Population-Based Registry