Predictors of Survival in Acute Myeloid Leukemia by Treatment Modality

Evaluations of efficacy of treatment modality in analyses on patients with acute myeloid leukemia (AML) often combine chemotherapy and stem cell transplantation (SCT). To account for the effect of SCT and determine the impact of chemotherapy alone, the National Cancer Data Base from 1998-2011 was analyzed.

Patients with AML from 1998-2011 aged 18-64 years were included. Chi-square analysis was used to assess the association between treatment and factors investigated. The Kaplan-Meier method was used to assess overall survival. Log-rank methods were used to determine factors significant for survival. Multivariable Cox regression analysis was used to determine the effect of chemotherapy alone, and both chemotherapy and SCT on survival while adjusting for other variables.

A total of 34,816 patients from the National Cancer Database were eligible for this study. Eighty-four percent of patients received chemotherapy alone, 8.3% no chemotherapy or SCT, and 7.5 % received both chemotherapy and SCT. Five-year survival for patients without chemotherapy without SCT was 12%, survival for the group treated with chemotherapy alone was 37.8% and for those receiving both chemotherapy and SCT was 44.1%. Treatment with chemotherapy only and chemotherapy plus SCT had a hazard ratio for death of 0.42 and 0.35 compared to no chemotherapy or SCT. Advanced age, male sex, Black race, diagnosis prior to 2004, multiple comorbidities, Medicare insurance, Medicaid insurance, no insurance, lower income and low education level, distance less than 30 miles from treatment Center, diagnosis and treatment at same facility, were independently associated with worse survival.

Survival analysis of AML in the National Cancer Database showed multiple factors to be independently associated with survival. Outcomes based on treatment suggest an improved survival when utilizing chemotherapy and SCT as the primary treatment modality.