Blood cancers

Acute leukaemia survival on a continuous improvement: Australian data

Five-year survival for people with acute leukaemia is increasing but could still do with a boost especially for older people with AML, Australian figures show.

A retrospective analysis of South Australian Cancer Registry data for the period 1980–2016 found 5-year survival for ALL improved from 44% to 69% and from 9% to 23% for AML.

Risk of death increased with age both for people with ALL (70–79 years v 0 –14years: HR, 11.1; 95% CI, 8.15–15.2) and those with AML (HR, 4.72; 95% CI, 3.33–6.69).

“Survival gains were greater (in both absolute and relative terms) for people with ALL than for those with AML, and for younger people,” it said.

The study, published in The MJA, said neither survival nor improvement in survival were influenced by socio-economic status or remoteness of residence.

“Our findings that remoteness, country of birth, and socio-economic status did not influence survival suggests that access to and quality of care for acute leukaemia is reasonably equitable in South Australia.”

The study said better supportive measures for managing infections and graft versus host disease would have influenced survival rates.

Co-author of the paper, Professor Brendon Kearney told the limbic that patients with ALL were further likely to benefit from newer treatments such as blinatumomab and CAR-T therapy.

“But they’ve only just come in and it’s too early to tell the impact of that in this study because you need 4-5 years,” he said.

“Bone marrow transplantation has been the biggest improvement for those who can have it in both AML and ALL.”

He said there was an urgent need for new targeted therapies in AML.

“As people get older the somatic mutations appear to be more complex and less responsive to therapy. And we are learning that the current treatments that younger people seem to do well with are just very toxic for older people and they do badly.”

He said the most recent advance, the combination of azacitidine and venetoclax, had an effect in some people but not in everybody.

“And so there is going to be a lot of focus on incremental targeting of treatments according to the mutational profile.”

He said the other thing needed in Australia was a comprehensive national database of leukaemia.

“It’s in the Cancer Plan that the Australian government has accepted late last year but it hasn’t been funded yet and it really is the other advance that we need, so that we know whatever we are doing is effective in improving outcomes.”

Professor Kearney, from the Royal Adelaide Hospital, said the study also demonstrated that outcomes in South Australia were equivalent to those in Australia and internationally.

He said that was important to locals given the incorrect dosing of cytarabine incident which occurred in the unit in 2014-2015.

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