The Outcome of Older Patients with Acute Myeloid Leukemia Based on the SEER Database in the Era of Targeted Therapy

Large-scale real-world studies are essential to assess the outcome of older acute myeloid leukemia (AML) patients in the targeted therapy era. Using the Surveillance, Epidemiology, and End Results (SEER) database, we investigated the epidemiology, clinical characteristics, and survival outcome of AML patients aged ≥ 60 years. From 2000 to 2021, the incidence of older AML patients showed an upward trend, with an Annual percentage change (APC) of 0.80% (95% CI: 0.35–1.27, P  = 0.0015). Unexpectedly, the proportion of therapy-related myeloid neoplasm (t-MN) decreased with age (60–69 years, 5.7%; 70–79 years, 3.9%; 80–89 years, 1.8%; ≥90 years, 1.0%; P  < 0.001). Among older AML patients, the 1-year overall survival (OS) rate increased from 19.6% in 2000–2008, to 24.8% in 2009–2016, and further to 29.6% in 2017–2021 ( P <0.001). Correspondingly, the 5-year OS rate rose from 5.0 % to 7.1 % and finally to 9.7 % ( P <0.001). Age-stratified analysis demonstrated that among patients aged 60–69, the 1-year OS rate reached 43.0% in 2017–2021 ( P  < 0.0001), with 3-year and 5-year OS rates increasing to 24.4% and 20.3%, respectively ( P  < 0.0001). Similarly, in the 70–79 years group, the 1-year, 3-year, and 5-year OS rates improved to 30.1%, 11.1%, and 7.07% during 2017–2021( P  < 0.0001). For those aged 80–89, the 1-year OS rate rose from 8.85% to 12.2% to 15.5%, while among the very elderly (≥ 90 years), it reached 7.97% in 2017–2021( P <0.05). These findings confirm that targeted therapies have substantially improved survival across all older AML patient groups, including the super-elderly (≥ 90 years).