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.
背景：急性髓系白血病（AML）是一种骨髓恶性肿瘤，诊断中位年龄为70岁。该疾病治疗难度大，尤其在老年患者中，其预后历来较差。过去二十年间，随着对疾病病理分子机制认识的深入，新药研发不断推进，治疗指南也经历了多次更新。 方法：本研究基于荷兰弗里斯兰省2005年至2023年间确诊的370例60岁及以上新发AML患者（依据欧洲白血病网2022标准定义），开展了一项基于人群的回顾性队列研究。 结果：在这组中位年龄为73岁的患者队列中，按照ELN标准通过完整骨髓分析进行AML分型的比例随时间显著提升，从49%（2005-2011年）增至86%（2022-2023年）。接受抗白血病治疗的患者比例持续上升（2005-2011：19%；2012-2016：64%；2017-2021：75%；2022-2023：74%），这主要得益于去甲基化药物的临床应用。随着2012年后更多患者符合治疗指征，强化化疗使用率（13%、27%、27%、5%）和干细胞移植率（3%、9%、27%、14%）呈现相似增长趋势，但在2022年维奈克拉上市后出现回落。四个时间段的中位总生存期分别为3.7、7.3、8.0和9.4个月。 结论：本研究揭示了近二十年来60岁及以上新诊断AML患者治疗结局的改善轨迹。
肿瘤(癌症)患者之家