COLUMBUS, Ohio – A global study led by The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC – James) sheds light on how age influences the outcomes of patients with acute myeloid leukemia (AML). This challenges the long-standing practice of dividing patients into younger and older groups for clinical trials and treatment decisions. Ann-Kathrin Eisfeld, MD, director of the Clara D. Bloomfield Center for Leukemia Outcomes Research at the OSUCCC – James, was senior and corresponding author for the study, which was published in the journal Leukemia. Karilyn Larkin, MD, a member of the Leukemia and Hematologic Malignancies Program at the OSUCCC – James, was co-first author. “Although AML predominantly affects older patients, it occurs in people of all ages, and patient outcomes strongly correlate with factors like age, race and the ability to do daily activities without help, as well as AML-associated genetic abnormalities,” said Eisfeld. Because increasing age is known to worsen survival for AML patients, it’s a major factor in determining treatment options like chemotherapy and clinical trials. However, an improved understanding of disease biology in recent years has led to better targeted therapies and drug combinations, so the use of age alone to classify patients and determine treatment is being challenged. “Age as a major factor for inclusion or exclusion from clinical trials could preclude patients from getting an effective therapy and could impede our understanding of the biology of disease, as well as response to therapy,” said Larkin. The study looked at gene-mutation patterns and survival correlations through five-year age intervals in two large groups of AML patients in Germany and the United States who ranged in age from 18 to 92. The researchers believe this was one of the first large-scale, global depictions of mutational patterns and patient outcomes in AML that included the entire adult age spectrum.  They didn’t intend to define “precise cut points” among age groups, but rather to show molecular patterns across ages and test whether associated survival patterns outweigh age-restricted definitions. The researchers report that, while they sought to challenge the relevance of chronological age in AML, they have in fact shown that age provides further risk stratification to patients in an almost continuous fashion with the passage of time, reducing the relevance of classifying patients into precise age groups. “Choosing a precise age cut-off such as 39 years for separating adolescents and young adult patients from older adults, or 59 years for identifying ‘younger’ and ‘older’ AML patients, does not seem to be supported by the results of our analyses,” said Larkin. “While our intention was to assess whether defined age cut-offs are supported by patterns of genetic alterations, our data tend to refute the existence of any unform cut-offs across the age spectrum.” “These findings challenge the long-standing practice of dividing patients into ‘younger’ and ‘older’ groups for clinical trial design and treatment decisions,” said Eisfeld. “Instead, the study highlights the importance of considering age as a continuous factor alongside genetic and molecular risk profiles.” Allowing for more flexible consideration of age among AML patients, she adds, would pave the way for more inclusive clinical trials and personalized treatment strategies, “ensuring that patients receive care tailored to their unique biology and not just their birthdate.” Other study co-authors from Ohio State include Deedra Nicolet; Krzysztof Mrozek, MD, PhD; James S. Blachly, MD; Alice Mims, MD; Christopher Walker, PhD; Michael Walker, PhD; Christopher Oakes, PhD; and Shelley Orwick. Media Contact: Mary Ellen Fiorino, Mary.Fiorino@osumc.edu