The effects of single and multi-agent chemotherapies in older patients with newly diagnosed acute myeloid leukemia

The study compared the effects of single and multi-agent chemotherapies on survival in older patients with newly diagnosed acute myeloid leukemia (AML) in a real-world setting. The main finding was that chemotherapy with multiple drugs improved survival in such patients, compared to single-agent therapy.

Older patients with AML often have poorer survival than younger ones. This is due to age-related weakness and coexistence of multiple diseases, also called comorbidity. Older patients often face chemotherapy-related toxicities as well. As a result, the intensity of therapeutic dosages is debated in such patients.

Recent studies showed that older adults with AML survived longer under multi-agent intense chemotherapy compared to single-agent ones. However, factors influencing the choice of chemotherapy in such patients are unknown.

The study analyzed records of 25,621 patients with newly diagnosed AML. Patients were aged 60 to 79 years. 70% of them received chemotherapy with multiple drugs. The use of multi-agent chemotherapy decreased with age, comorbidity and AML types. 

The survival rate after 1 year was 43% in patients who had multi-agent chemotherapy. This was compared to 28% in the single-agent chemotherapy group. Overall survival (OS) after 1 year was particularly high for patients aged 60-69 years, those with good-risk AML and Charlson comorbidity score (CCS) of 0-1. CCS scale depicts the seriousness of comorbidity. A lower score indicates fewer comorbid conditions. OS was also higher in patients who did not receive bone marrow transplants. The chances of transplantation following treatment was 9% after multi-agent and 1% after single-agent chemotherapy.

The authors concluded that multi-agent chemotherapy improved OS in older patients with newly diagnosed AML. Survival was particularly better in patients younger than 70 years, with good-risk AML and fewer associated medical conditions.