A multicenter real-world study of clinical outcomes in octogenarians and older patients with acute myeloid leukemia.

Abstract

Acute myeloid leukemia (AML) predominantly affects older adults; however, patients aged ≥ 80 years remain underrepresented in clinical trials, and their real-world outcomes and prognostic determinants remain unclear. This multicenter retrospective cohort study (SNOWFALL: Study of Northern Outcomes With Frailty and Acute Leukemia in Late Life) used the Hokkaido Leukemia Net registry. Consecutive patients aged ≥ 80 years with newly diagnosed AML between 2020 and 2024 were analyzed. Clinical characteristics, treatments, overall survival (OS), relapse-free survival (RFS), cumulative incidence of relapse (CIR), and prognostic performance of a clinical-biological risk score were evaluated. A total of 154 patients (median age, 84 years) were evaluated, with a median OS of 237 days. Although unadjusted OS did not differ significantly between patients aged 80-84 years and those aged ≥ 85 years, multivariable analysis identified age ≥ 85 years, Eastern Cooperative Oncology Group performance status (ECOG PS) ≥ 2, and high clinical-biological risk as independent adverse factors for OS. Increasing age and ECOG PS ≥ 2 were independently associated with 30-day mortality (odds ratios per year, 1.16 and 3.35, respectively). RFS and CIR did not differ significantly by age group. Non-relapse mortality analysis showed no significant trend toward higher NRM in patients aged ≥ 85 years and those with ECOG PS ≥ 2. In this real-world cohort, patients aged ≥ 80 years demonstrated poor outcomes. Prognosis may be more strongly associated with clinical vulnerability than with chronological age or relapse-related outcomes, highlighting the limitations of age-based risk models and the need for refined, clinically informed risk stratification and treatment strategies tailored to very elderly patients with AML.