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Abstract

 ePoster TRANSFUSION BURDEN ON OLDER PATIENTS WITH ACUTE MYELOID LEUKEMIA RECEIVING LOW-INTENSITY TREATMENTS

Abstract: EP1739

Type: e-Poster

Background
Acute myeloid leukemia (AML) is a hematologic malignancy characterized by the rapid proliferation of abnormally differentiated myeloid cells into the blood, bone marrow and other tissues, resulting in decreased production of normal blood cells. To optimize treatment outcomes and manage symptoms, red blood cell (RBC), and/or platelet transfusions may be used to supplement low-intensity treatments in older patients with AML. However, data on the overall transfusion burden in this population are limited.

Aims
To quantify transfusion requirements amongst older patients with AML receiving low-intensity treatments.

Methods
This is a retrospective observational study of the United States Surveillance, Epidemiology, and End Results program data (Jan 1, 2010 – Dec 31, 2015) linked to Medicare claims data (up to Dec 31, 2017). Adults aged ≥ 60 years, newly diagnosed with AML, who initiated low-intensity treatment within 90 days from diagnosis date, and had at least 12 months of continuous Part A and Part B coverage before the diagnosis date were included. Descriptive analyses were conducted to quantify patient baseline characteristics, treatment patterns, transfusion requirements, and transfusion independence (≥56 days transfusion free).

Results
A total of 1,776 older patients with AML who received low-intensity treatments were identified. Only hypomethylating agents azacitidine [n=877 (51%)] and decitabine [n=899 (49%)] were included; low-dose cytarabine was excluded due to small sample size and limited information on cytarabine doses in administrative claims data. The mean age was 77.1 years; 57% were female; 88% were white; mean (±SD) National Cancer Institute co-morbidity score was 1.27 ± 2.06; 26% with prior myelodysplastic syndrome/myeloproliferative neoplasms; and 17% with indicators of poor performance status (defined as the use of oxygen and related respiratory therapy supplies, wheelchair and supplies, home health agency services, and skilled nursing facility services). Within the 56-day period prior to treatment initiation, more patients had baseline RBC transfusion dependence [n=1,004 (57%)] than baseline platelet transfusion dependence [n=390 (22%)]. A high proportion of low-intensity treated patients required ≥ 1 RBC transfusion [n=1,218 (76%)] or ≥ 1 platelet transfusion [n=729 (45%)] in the first month of treatment initiation. The proportion of patients receiving transfusions decreased each month over the course of the treatment, and stabilized 6 months after treatment initiation. More transfusions were required during 1L low-intensity treatment for patients with baseline transfusion dependence (Fig 1). At a mean treatment duration of 152 days, n=223 (22%) patients with RBC baseline transfusion dependence became RBC transfusion independent, for a mean of 94 days; n=92 (24%) patients with platelet baseline transfusion dependence became platelet transfusion independent, for a mean of 98 days.

Conclusion
Transfusion requirement is a burden amongst older patients with AML receiving low-intensity treatment. RBC transfusions were more commonly provided than platelet transfusions. Amongst those receiving 1L low-intensity therapy with baseline transfusion dependence, < 25% of patients converted and became transfusion independent. Novel treatment options that can reduce transfusion requirements and help more patients convert from baseline transfusion dependence to transfusion independence, which may potentially improve quality of life and reduce cost of care, are needed.

Session topic: 35. Quality of life, palliative & supportive care, ethics and health economics

Keyword(s): AML, Transfusion

Abstract: EP1739

Type: e-Poster

Background
Acute myeloid leukemia (AML) is a hematologic malignancy characterized by the rapid proliferation of abnormally differentiated myeloid cells into the blood, bone marrow and other tissues, resulting in decreased production of normal blood cells. To optimize treatment outcomes and manage symptoms, red blood cell (RBC), and/or platelet transfusions may be used to supplement low-intensity treatments in older patients with AML. However, data on the overall transfusion burden in this population are limited.

Aims
To quantify transfusion requirements amongst older patients with AML receiving low-intensity treatments.

Methods
This is a retrospective observational study of the United States Surveillance, Epidemiology, and End Results program data (Jan 1, 2010 – Dec 31, 2015) linked to Medicare claims data (up to Dec 31, 2017). Adults aged ≥ 60 years, newly diagnosed with AML, who initiated low-intensity treatment within 90 days from diagnosis date, and had at least 12 months of continuous Part A and Part B coverage before the diagnosis date were included. Descriptive analyses were conducted to quantify patient baseline characteristics, treatment patterns, transfusion requirements, and transfusion independence (≥56 days transfusion free).

Results
A total of 1,776 older patients with AML who received low-intensity treatments were identified. Only hypomethylating agents azacitidine [n=877 (51%)] and decitabine [n=899 (49%)] were included; low-dose cytarabine was excluded due to small sample size and limited information on cytarabine doses in administrative claims data. The mean age was 77.1 years; 57% were female; 88% were white; mean (±SD) National Cancer Institute co-morbidity score was 1.27 ± 2.06; 26% with prior myelodysplastic syndrome/myeloproliferative neoplasms; and 17% with indicators of poor performance status (defined as the use of oxygen and related respiratory therapy supplies, wheelchair and supplies, home health agency services, and skilled nursing facility services). Within the 56-day period prior to treatment initiation, more patients had baseline RBC transfusion dependence [n=1,004 (57%)] than baseline platelet transfusion dependence [n=390 (22%)]. A high proportion of low-intensity treated patients required ≥ 1 RBC transfusion [n=1,218 (76%)] or ≥ 1 platelet transfusion [n=729 (45%)] in the first month of treatment initiation. The proportion of patients receiving transfusions decreased each month over the course of the treatment, and stabilized 6 months after treatment initiation. More transfusions were required during 1L low-intensity treatment for patients with baseline transfusion dependence (Fig 1). At a mean treatment duration of 152 days, n=223 (22%) patients with RBC baseline transfusion dependence became RBC transfusion independent, for a mean of 94 days; n=92 (24%) patients with platelet baseline transfusion dependence became platelet transfusion independent, for a mean of 98 days.

Conclusion
Transfusion requirement is a burden amongst older patients with AML receiving low-intensity treatment. RBC transfusions were more commonly provided than platelet transfusions. Amongst those receiving 1L low-intensity therapy with baseline transfusion dependence, < 25% of patients converted and became transfusion independent. Novel treatment options that can reduce transfusion requirements and help more patients convert from baseline transfusion dependence to transfusion independence, which may potentially improve quality of life and reduce cost of care, are needed.

Session topic: 35. Quality of life, palliative & supportive care, ethics and health economics

Keyword(s): AML, Transfusion

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