Poster Session I: Acute myeloid leukemia - Clinical
While the prognosis for adults with acute myeloid leukemia (AML) is historically poor, advances in supportive care and new therapeutics such as blood and marrow transplant (BMT) and hypomethylating agents may have improved overall outcomes. In the Canadian province of Manitoba, all patients with AML are managed at a single cancer centre with support from a community cancer program. Clinical and demographic data are collected in a provincial cancer registry. This registry captures all cases of AML, increasing the reliability of population-based data as case ascertainment and follow-up follow a uniform approach.
We sought to describe the clinical characteristics, incidende and relative survival for patients with AML in the province of Manitoba, with attention to temporal trends and outcomes in rural patients, where access to care may be challenging.
We collected data on consecutively diagnosed adult cases of AML that were reported to the Manitoba Cancer Registry (MCR) from 1990 - 2014. Life tables from Statistics Canada were used as a reference for expected survival in the general population. Patient demographics were stratified by age, time period and residence at diagnosis. Two-year age-standardized relative survival estimates of patients in Manitoba with AML were estimated using the cohort method within various subcategories, including time period of diagnosis (in 5 year increments), sex and urban (Winnipeg) versus non-Winnipeg location.
A total of 910 patients from the ages of 15 to 99 were diagnosed from 1990 - 2014 with available survival data to 2016. Of the 910 patients, 517 were men and 393 were women and 511 (56%) were residents of Winnipeg at diagnosis. Two-year crude relative survival estimates by time period and age group demonstrated improving relative survival for each age quintile category within each 5-year time period, with the most notable increase over time in patients aged 15-44 and 45-54. Total two-year age-standardized relative survival for all patients was 20.37% (CI 95% 17.81-23.05%). Two-year age-standardized relative survival in males was 19.22% (CI 95% 15.95-22.73%) and 21.93% (CI 95% 17.88-26.25%) in females. Two-year age-standardized relative survival by residence at diagnosis was 20.32% (CI 95% .16.92-23.94%) for urban (Winnipeg) residents, and 20.54% (CI 95% 16.74-24.62%) for those outside of Winnipeg.
We demonstrate improved relative survival in adult AML over time, most notably in adults aged 15-54, where BMT has played an increasingly important therapeutic role. Advanced supportive care and hypomethylating agents may also have contributed to improved outcomes, especially in older patients. Similar relative survival for urban and rural patients supports the benefits of a centralized and coordinated leukemia centre with its closely linked community cancer program.