Older patients with chronic myelomonocytic leukemia (CMML) who are treated with hypomethylating agents reduce their risk of disease-related mortality by 28%, according to new research published in Cancer (published online June 16, 2017; doi:10.1002/cncr.30814).
Multiple hypomethylating drugs have been approved for the treatment of CMML in recent years, including azacitidine (2004) and decitabine (2006). However, the correlation between these agents and survival benefits for those who take them—specifically older adults—have yet to be studied.
Amer M Zeidan, MBBS, MHS, department of internal medicine, Yale University, and colleagues conducted a study to assess the survival benefits for older patients (aged ≥ 66 years) with CMML after undergoing hypomethylating drug agent therapy. A total of 1378 patients who were initially diagnosed between 2001 and 2011 were selected from the Surveillance, Epidemiology, and End Results-Medicare database. Researchers used propensity score matching to compare patients who had been diagnosed before hypomethylating agent approvals (2001-2003) to patients who had been diagnosed after approvals (2007-2011). Primary outcome of the assessment was change in overall survival (OS) between the two groups.
Researchers also used a second matched cohort of patients who did not receive hypomethylating agent therapy after approvals and patients diagnosed before approvals to evaluate survival changes attributable to other potential differences between the time periods, including improved supportive care.
Among the total patient sample, the median OS was 13 months, with 18.8% of patients receiving hypomethylating drugs.
In the primary matched analysis, median OS was 17 months and 11 months for those patients diagnosed after the approvals versus before the approvals, respectively. (HR, 0.72; 95% CI, 0.58-0.91; P = .005).
Secondary analysis showed that the risk of disease-related mortality was not statistically significant between the patients who did not use hypomethylating drugs diagnosed in 2007-2011 and those diagnosed in 2001-2003 (HR, 1.09; 95% CI, 0.91-1.32; P = .34).
Researchers concluded that the use of hypomethylating agent therapy is associated with a significant reduction in the risk of death for older patients with CMML. Additionally, researchers noted that improvements in supportive care do not have any influence in temporal improvements in OS in this population.—Zachary Bessette