| Objective Acute myeloid leukemia is the most common acute leukemia.Acute myeloid leukaemia(AML)is a genetically heterogeneous disease,characterized by the accumulation of acquired genetic changes in haematopoietic progenitor cells that alter mechanisms of self-renewal,proliferation and differentiation.It is the most common myeloid leukaemia in adults.In 2019,it is estimated that there will be 21,450 new cases of acute myeloid leukemia and an estimated 10,920 people will die of this disease in America.Based on data from SEER 18 2009-2015,only about 28.3%of the patients can survive for over 5 years.The elderly get higher morbidity and mortality.Older patients have poor physical status,complicated underlying diseases,and complicated genetic variation,which make it more difficult to cure.This study mainly explores the factors affecting the overall survival of elderly patients with acute myeloid leukemia and predicts the risks.Methods 104 AML were devided into two groups according to whether chemotherapy was conducted.All patients were first diagnosed with acute myeloid leukemia and received hospital treatment in the Department of Hematology in our hospital from 2009.01-2018.10.The survival curve and P value of the two groups were compared.69 elderly patients accepted chemotherapy.13 factors was involved in Kaplan-Meier survival analysis including hypomethylating agents(HMA),karyotypic abnormality,gene mutation,gender,age,PS score,CCI score,white blood cell count,hemoglobin,platelet,lactate dehydrogenase,albumin and bone marrow blasts.The factors with P<0.05 after Log-Rank test were included to the multivariate Cox regression analysis.Results There were 35 patients in the palliative treatment group and 69 patients in the combination chemotherapy group.The median overall survival was 4.7 months and 16.9 months(P<0.05)separately,the difference was statistically significant.There were 66 males and 38 females.34 cases were 60-64 years old,33 cases were 65-69 years old,28 cases were 70-74 years old,13 cases were 75-79 years old,6 cases were 80 years old and above,and the median age was 67(60,93)years old.Among the various types,9 cases belong to M1,45 cases belong to M2,M4 and M6 both have only one case,16 cases were untyped.M2(42.3%)was the most common,and M2a was more common than M2b,accounting for 84%.47(45.2%)patients were not associated with other diseases,and 57(54.8%)patients were associated with comorbidities.Common comorbidities involve hypertension,stroke(including cerebral infarction and cerebral hemorrhage),lung disease(including bronchiectasis,asthma,tuberculosis,chronic obstructive pulmonary disease(COPD),etc),coronary heart disease and diabetes.20 patients only combined with one other disease,accounting for 19.23%.According to whether the survival curve depicted by chemotherapy indicates the difference in overall survival between the palliative treatment group and the chemotherapy group,the curve of the chemotherapy group is above,there is no crossover,and the overall survival of elderly AML chemotherapy is better.Kaplan-Meier survival analysis showed the P value of whether applying hypomethylating agents,PS scores,ALB level,abnormal karyotype and gene mutation is less than 0.05,and the difference was statistically significant.Cox multivariate regression showed the coefficients(B)of demethylation drug is-0.693,and the RRis 0.528.The others’ coefficients(B)is above zero,and RR is above 1.Hypomethylating agents are significant protective factors,Abnormal karyotype(except for benign karyotypes)and genetic mutations(non-NPM1 or CEBPA double mutations)increase the risks of death for elderly patients with AML.Lower ALB and higher PS scores also predict worse overall survival.Conclusions There are many factors affecting the overall survival of elderly patients with acute myeloid leukemia.Active chemotherapy,especially combined with hypomethylating agents,can significantly improve the prognosis.Patients with non-benign karyotypes and gene mutations excluding NPM1 and CEBPA double mutations have a high risk of death. |
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