OBJECTIVES: AML treatment aims to achieve remission with minimal toxicity. Patients over 60 have poorer prognosis due to genetic factors and lower tolerance to high-dose chemotherapy.

For previously untreated patients unfit for intensive-therapy, the VIALE-A-phase-III-trial showed better outcomes with azacitidine+venetoclax compared to azacitidine alone. Choosing between intensive and less intensive-chemotherapy remains a topic of debate for patients aged 60-75.

This study explores treatment decisions for AML patients aged 60-75 in France and Germany, focusing on patient characteristics and factors influencing treatment choices.

METHODS: 293 anonymous patient charts (France: 152 Germany: 141) were reported by onco-hematologists in France and Germany (Q4.2023).

RESULTS:

Age-distribution: 60-64y: 95 patients, 65-69y: 84, 70-74y: 114. 166 were fit for intensive chemotherapy (IC), 17 borderline fit, 110 unfit.

Patient fit for IC: favorable ELN risk (39%), intermediate (58%), adverse (3%). ECOG 0 (43%), 1 (48%). NPM1 status mutated (8%), unmutated (51%), not tested (29%), (France 42% versus Germany 11%). Testing for Flt3 ITD and TKD was less frequent in France (33% and 28%) than in Germany (6% for both).

1^st line IC treatment included the "3+7" regimen (30%), "3+7" plus midostaurin (25%) (France 21% and 16%, Germany 37% and 41%). Venetoclax-based therapy: France (3%) versus Germany (23%).

Unfit population: favorable ELN risk (25%), intermediate (33%), adverse (31%). ECOG 1 (54%), 2 (27%), 3 (11%). Unknown NPM1 status: Germany (46%), France (20%). Flt3 ITD: not tested Germany 28%, France 16%. TKD: not tested Germany 28%, France 22%.

"3+7" regimen (0%), "3+7+midostaurin" (2%). Venetoclax-based therapy (49%): azacitidine+venetoclax (41%), France (45%), Germany (52%).

CONCLUSIONS: In newly-diagnosed AML patients aged 60-75, key drivers for IC eligibility include age, comorbidities, ECOG status. Favorable and intermediate ELN risk molecular markers (including NPM1 mutations) are considered for borderline fit patients. We observed higher non-testing rates in France among fit patients and in Germany among unfit patients.