AML survival improved across three decades in younger adults

Researchers analyzed data from six randomized trials conducted by HOVON-SAKK, covering 5,073 younger adults with newly diagnosed acute myeloid leukemia (AML) enrolled from 1987 to 2017. Patients were grouped by decade of diagnosis. Two multistate models assessed transitions from induction treatment to complete remission (CR), postremission treatment and death. Estimates were adjusted for age and 2017 European LeukemiaNet risk classification.

Five-year overall survival rose from 33% (±2%) in 1987–1996 to 47% (±1%) in 2007–2017. CR rates increased from 77.5% to 83.9%, while 60-day mortality fell from 9.9% to 7.8%. Allogeneic hematopoietic stem-cell transplantation as postremission treatment increased from 16.6% to 48.3%. Five-year multistate survival increased from 28.8% to 47.4% for patients with intermediate-risk disease and from 11.3% to 26.1% for those with adverse-risk disease. The authors attributed much of the improvement to better survival among patients in CR who proceeded to transplantation.

The analysis describes changes across trial cohorts; it does not establish that increased transplantation alone caused the survival gains. The authors propose multistate survival as an endpoint that captures remission, postremission treatment and subsequent survival.