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Real-world treatment patterns and clinical outcomes in patients with AML in Japan who were ineligible for first-line intensive chemotherapy

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Abstract

Acute myeloid leukemia (AML) predominantly affects elderly adults, and its prognosis worsens with age. Treatment options for patients in Japan ineligible for intensive chemotherapy include cytarabine/aclarubicin ± granulocyte colony-stimulating factor (CA ± G), azacitidine (AZA), low-dose cytarabine (LDAC), targeted therapy, and best supportive care (BSC). The country’s aging population and the evolving treatment landscape are contributing to a need to understand treatment pathways and associated outcomes. This retrospective chart review evaluated outcomes in patients across Japan with primary/secondary AML who were ineligible for intensive chemotherapy and began first-line treatment or BSC between 01/01/2015 and 12/31/2018. The primary endpoint was overall survival (OS); secondary endpoints included progression-free survival (PFS) and healthcare resource utilization (HRU). Of 199 patients (58% > 75 years), 121 received systemic therapy (38 CA ± G, 37 AZA, 7 LDAC, 39 other) and 78 received BSC. Median OS was 5.4, 9.2, 2.2, 3.8, and 2.2 months for CA ± G, AZA, LDAC, other systemic therapy, and BSC, respectively; median PFS was 3.4, 7.7, 1.6, 2.3, and 2.1 months, respectively. HRU rates were uniformly high, with > 80% patients hospitalized in each cohort. The poor clinical outcomes and high HRU among Japanese AML patients who are ineligible for intensive chemotherapy highlight an unmet need for novel therapies.

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Acknowledgements

Medical writing support was provided by Hayley Ellis, PhD, of Fishawack Communications Ltd, and funded by AbbVie.

Funding

AbbVie funded this study and participated in the study design, research, analysis, data collection, interpretation of data, reviewing, and approval of the publication. All authors had access to relevant data and participated in the drafting, review, and approval of this publication. No honoraria or payments were made for authorship.

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Authors and Affiliations

Authors

Contributions

Study conception and design: Yoshiko Kawakami, Tetsuo Morita, Ikue Taneike, Masahiko Nakayama, Yinghui Duan, Belen Garbayo Guijarro, Alexander Delgado, and Cynthia Llamas. Collection and assembly of data: All authors. Analysis and interpretation of data: All authors. Manuscript writing, editing, and approval: All authors.

Corresponding author

Correspondence to Chikashi Yoshida.

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Conflict of interest

C. Yoshida: Investigator on AbbVie-funded clinical study. Honoraria from Bristol Myers Squibb, Novartis Pharma KK, Pfizer Japan Inc., Otsuka Pharmaceutical., AbbVie, Janssen Pharmaceutical KK, Nippon Shinyaku Co., Ltd., Chugai Pharmaceutical Co., Ltd. Research funding from Bristol Myers Squibb. T. Kondo: Advisory role for Astellas Pharma, Otsuka Pharmaceutical. Honoraria from Astellas Pharma, Bristol Myers Squibb, Otsuka Pharmaceutical, Novartis, and Sumitomo Dainippon Pharma. T. Ito: Research funding from AbbVie and Bristol Myers Squibb. Honoraria from AbbVie, Bristol Myers Squibb, Takeda Pharmaceutical Sanofi, CSL Behring, and Novartis. M. Kizaki, Y. Morita, T. Eto, Y. Katsuoka, N. Takezako, N. Uoshima, J. Ando, A. Mori, A. Satake, J. Watanabe: No potential conflicts of interest are reported. K. Yamamoto, T. Komeno: Investigator on AbbVie-funded clinical study. T. Miyamoto: Honoraria from AbbVie, Astellas Pharmaceutical, Astellas Amgen Pharmaceutical, Bristol Myers Squibb, Celgene, Merck Sharp & Dohme, Otsuka Pharmaceutical, and Takeda Pharmaceutical. K. Imada: Honoraria from Astellas Pharma, Bristol Myers Squibb, Celgene, Chugai Pharmaceutical, Kyowa Hakko Kirin, Nippon Shinyaku, Novartis, Otsuka Pharmaceutical, and Takeda Pharmaceutical. Y. Ishikawa: Personal fees from AbbVie, Astellas Pharma, Chugai Pharmaceutical, Daiichi-Sankyo, FUJIFILM, Kyowa Hakko Kirin, Nippon Shinyaku, Novartis, and Pfizer. Y. Kawakami, T. Morita, I. Taneike, M. Nakayama, Y. Duan, B. Garbayo Guijarro, A. Delgado, C. Llamas: Employees of AbbVie and may hold stock or options. H. Kiyoi: Research funding from AbbVie, Astellas Pharma, Bristol Myers Squibb, Chugai Pharmaceutical, CURED Inc., Daiichi Sankyo, Eisai, FUJIFILM, Kyowa Hakko Kirin, Nippon Shinyaku, Novartis, Otsuka Pharmaceutical, Perseus Proteomics, Pfizer, Sanofi, Sumitomo Dainippon Pharma, Takeda Pharmaceutical, and Zenyaku Kogyo. Honoraria from Astellas Pharma, Bristol Myers Squibb, and Novartis.

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Department and institution in which the work was done: Kyushu University Hospital, Department of Hematology, Oncology & Cardiovascular Medicine. Hamanomachi Hospital, Department of Hematology. Okayama City General Medical Center, Department of Hematology. Osaka Red Cross Hospital, Department of Hematology. Kindai University Hospital, Department of Hematology and Rheumatology. Kansai Medical University Hospital, Department of Hematology-Oncology. Japanese Red Cross Kyoto Daini Hospital, Department of Hematology. Nagoya University Hospital, Department of Hematology. Juntendo University Hospital, Department of Hematology. National Hospital Organization Disaster Medical Center, Department of Hematology. Saitama Medical Center, Saitama Medical University, Department of Hematology. National Hospital Organization Mito Medical Center, Department of Hematology. Sendai Medical Center, Department of Hematology. Aiiku Hospital, Department of Hematology and Blood Disorders Center.

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Yoshida, C., Kondo, T., Ito, T. et al. Real-world treatment patterns and clinical outcomes in patients with AML in Japan who were ineligible for first-line intensive chemotherapy. Int J Hematol 116, 89–101 (2022). https://doi.org/10.1007/s12185-022-03334-8

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