The Importance of Time at Home Among Older AML Patients

Older adults with acute myeloid leukemia (AML) treated with hypomethylating agents (HMAs) have more time at home (TAH), which is a critical consideration when deciding on treatment, according to a study presented at the 2022 American Society of Clinical Oncology Annual Meeting.

In this study, Daniel R. Richardson and colleagues analyzed 7,946 adults (88% white, 57% male) with a new diagnosis of AML between 2004 and 2016. The population of interest were stratified by treatment (high-intensity chemotherapy [HIC] vs. HMA vs. other treatments). The primary endpoint of interest was TAH, while demographics, comorbidities, frailty, and transfusion dependence served as covariates.

Adults receiving HIC spent less time at home and more time hospitalized than those receiving HMAs each month in the first year. The differences in TAH between the HIC and HMA cohorts were most pronounced in the first 3 months (1^st: 49.5% vs. 86.5%; 2^nd: 68.2% vs. 84.1%; 3^rd: 77.3% vs. 86.8%). Additionally, total TAH over 12 months was lower for those receiving HIC compared to HMA (51.7% [187 days] vs. 56.9% [205 days]). Transfusion dependence (≥ 1/month) was associated with decreased TAH at 1 month (odds ratio [OR] 0.81; P<.001) and 12 months (OR 0.90; P=.04). Other covariates were not associated with TAH.

“Although intensive chemotherapy resulted in slightly longer survival, older adults treated with HMAs had more time at home. Treatment decision-making should incorporate patient preferences for prolonging survival vs. increasing time at home,” the researchers concluded.