TY - JOUR
T1 - Hypomethylating agent therapy use and survival in older patients with chronic myelomonocytic leukemia in the United States
T2 - A large population-based study
AU - Zeidan, Amer M.
AU - Hu, Xin
AU - Long, Jessica B.
AU - Wang, Rong
AU - Ma, Xiaomei
AU - Podoltsev, Nikolai A.
AU - Huntington, Scott F.
AU - Gore, Steven D.
AU - Davidoff, Amy J.
N1 - Funding Information:
This research was partly funded by the Dennis Cooper Hematology Young Investigator Award (to Amer M. Zeidan) and the National Cancer Institute (P30 CA016359; to Xiaomei Ma).
Publisher Copyright:
© 2017 American Cancer Society
PY - 2017/10/1
Y1 - 2017/10/1
N2 - BACKGROUND: Despite the approval of azacitidine in 2004 and the approval of decitabine in 2006 in the United States for chronic myelomonocytic leukemia (CMML), the overall survival (OS) benefit with hypomethylating agent (HMA) therapy is unclear. METHODS: Older adults (age ≥ 66 years) who had been diagnosed with CMML from 2001 to 2011 were selected from the Surveillance, Epidemiology, and End Results–Medicare database, and propensity score matching was used to match patients who had been diagnosed after HMA approval (2007-2011) and had received HMA treatment with patients diagnosed before HMA approval (2001-2003). Cox proportional hazards models with the matched sample were used to assess the change in OS. A second matched cohort of patients who did not receive HMA after approval and patients diagnosed before HMA approval was used to evaluate survival change attributable to other potential differences between the 2 time periods, such as improved supportive care. RESULTS: Among 1378 older adults diagnosed with CMML, the median OS was 13 months, and 18.8% received HMAs. In the primary matched analysis, with 225 HMA users diagnosed in 2007-2011 and 395 patients diagnosed in 2001-2003, the median OS times were 17 and 11 months, respectively (hazard ratio, 0.72; 95% confidence interval [CI], 0.58-0.91; P =.005). In a secondary analysis, the risk of death did not differ between 395 propensity score–matched HMA nonusers diagnosed in 2007-2011 and 484 patients diagnosed in 2001-2003 (hazard ratio, 1.09; 95% CI, 0.91-1.32; P =.34). CONCLUSIONS: Despite limited evidence, HMAs are commonly used to treat older CMML patients. The use of HMAs was associated with a 28% reduction in the risk of death in adjusted analyses. Improvements in supportive care do not appear to account for temporal improvements in OS. Cancer 2017;123:3754–3762.
AB - BACKGROUND: Despite the approval of azacitidine in 2004 and the approval of decitabine in 2006 in the United States for chronic myelomonocytic leukemia (CMML), the overall survival (OS) benefit with hypomethylating agent (HMA) therapy is unclear. METHODS: Older adults (age ≥ 66 years) who had been diagnosed with CMML from 2001 to 2011 were selected from the Surveillance, Epidemiology, and End Results–Medicare database, and propensity score matching was used to match patients who had been diagnosed after HMA approval (2007-2011) and had received HMA treatment with patients diagnosed before HMA approval (2001-2003). Cox proportional hazards models with the matched sample were used to assess the change in OS. A second matched cohort of patients who did not receive HMA after approval and patients diagnosed before HMA approval was used to evaluate survival change attributable to other potential differences between the 2 time periods, such as improved supportive care. RESULTS: Among 1378 older adults diagnosed with CMML, the median OS was 13 months, and 18.8% received HMAs. In the primary matched analysis, with 225 HMA users diagnosed in 2007-2011 and 395 patients diagnosed in 2001-2003, the median OS times were 17 and 11 months, respectively (hazard ratio, 0.72; 95% confidence interval [CI], 0.58-0.91; P =.005). In a secondary analysis, the risk of death did not differ between 395 propensity score–matched HMA nonusers diagnosed in 2007-2011 and 484 patients diagnosed in 2001-2003 (hazard ratio, 1.09; 95% CI, 0.91-1.32; P =.34). CONCLUSIONS: Despite limited evidence, HMAs are commonly used to treat older CMML patients. The use of HMAs was associated with a 28% reduction in the risk of death in adjusted analyses. Improvements in supportive care do not appear to account for temporal improvements in OS. Cancer 2017;123:3754–3762.
KW - Epidemiology
KW - Medicare
KW - Surveillance
KW - and End Results (SEER)
KW - azacitidine
KW - chronic myelomonocytic leukemia (CMML)
KW - decitabine
KW - effectiveness
KW - hypomethylating agents
KW - survival
UR - http://www.scopus.com/inward/record.url?scp=85021445883&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85021445883&partnerID=8YFLogxK
U2 - 10.1002/cncr.30814
DO - 10.1002/cncr.30814
M3 - Article
C2 - 28621841
AN - SCOPUS:85021445883
SN - 0008-543X
VL - 123
SP - 3754
EP - 3762
JO - Cancer
JF - Cancer
IS - 19
ER -