Acute myeloid leukemia

Acute myeloid leukaemia (AML) is a heterogeneous clonal disorder characterised by the arrest of differentiation of the progenitor cells (“blasts”) coupled with an accumulation of immature progenitors in the bone marrow, resulting in hematopoietic failure (1):

• AML is generally a disease of older adults - median age at diagnosis between 65 and 70 year of age (2)
• in the UK, approximately 66% of cases are diagnosed in people aged 65 years or over (2)
• in the UK, 56% of AML cases are in males and 44% are in females (2)
• the overall cure rate for patients between 18 and 60 years of age with AML is 35% to 40% (3)
• the overall outlook for older patients is poorer than that of younger patients: 5-year relative survival from the time of diagnosis is 38.9% for patients aged 50 to 64 years, and 11.2% for patients aged >65 years. (4,5)
• AML in older individuals is a more recalcitrant disease
  • the disease tends to be less proliferative with average bone marrow blast counts of 20% in those older than 60 and 40% in those younger than 60. When compared with those younger than 56, those older than 56 are less likely to have favourable cytogenetics (16% vs. 5%) and more likely to have unfavourable cytogenetics (33% vs. 50%) (6)

References:

1. Pollyea DA, Kohrt HE, Medeiros BC. Acute myeloid leukaemia in the elderly: a review. Br J Haematol. 2011 Mar;152(5):524-42
2. Cancer Research UK. Acute myeloid leukaemia (AML) incidence statistics. Jul 2024 [internet publication].
3. Döhner H, Weisdorf DJ, Bloomfield CD. Acute myeloid leukemia. N Engl J Med. 2015 Sep 17;373(12):1136-52.
4. National Cancer Institute. Surveillance, Epidemiology, and End Results Program. SEER*Explorer [internet publication].
5. Ossenkoppele G, Löwenberg B. How I treat the older patient with acute myeloid leukemia. Blood. 2015 Jan 29;125(5):767-74.
6. Blood Rev. 2008 Nov;22(6):311-20