Objective  To investigate the clinical features, therapeutic methods, therapeutic efficacy, and prognostic characteristics of older patients with acute myeloid leukemia (AML).

  Methods  We collected data from 134 older patients with AML treated at Peking University International Hospital between January 2015 and February 2023. White blood cell count, bone marrow primitive cell count, cytogenetic and molecular characteristics, and European LeukemiaNet (ELN) risk stratification at initial diagnosis were retrospectively analyzed. Patients were assigned into two groups according to treatment plan―high-intensity chemotherapy and low-dose treatment―to determine whether intensive chemotherapy would yield survival benefits during treatment and the factors affecting survival.

  Results  Among 36 patients treated with high-intensity chemotherapy, 22 (61.1%) achieved complete response (CR); among 90 treated with low-intensity therapy, 46 (51.1%) achieved CR; and among 19 treated with azacitidine (AZA) + venecra (VEN), 14 (73.7%) achieved CR. Median overall survival (OS) was 15 months for high-intensity chemotherapy and 14.5 months for low-intensity treatment (P=0.226). According to ELN risk stratification, patients in the low, medium, and high risk groups exhibited OS of 18, 14, and 9 months, respectively (P=0.009). OS for high-intensity chemotherapy and low-dose therapy was 22 and 15 months in the low-risk group (P=0.745), 9 and 15 months in the medium-risk group (P=0.783), and 9 and 8 months in the high-risk group (P=0.739), respectively. Patients in the intensive chemotherapy group (n=36) had an OS of 15 and 17 months (P=0.689) compared with AZA+VEN treatment (n=19). The prognosis of six patients with TP53 mutation was significantly worse than those without the mutation, and the median OS was 2 months and 14 months, respectively (P=0.004). One- and 3-year survival rates for the low-, medium- and high-risk groups were 79%, 53%, and 44%,and 41%, 20%, and 3%, respectively. Multivariate analysis revealed that high peripheral blood white blood cell count (P=0.034), ELN risk stratification (P=0.002), and complications (P=0.017) were correlated with OS, while treatment intensity, age, sex, and bone marrow primitive cell count were not significantly correlated with OS.

  Conclusions  High-intensity chemotherapy did not yield a significant survival benefit in older patients with AML; however, this result needs to be confirmed in patients at low risk. Patients with TP53 mutations had a poor prognosis. Multivariate analyses revealed that baseline molecular characteristics, leukocyte count, and comorbidities were more important than treatment intensity in predicting survival among older patients with AML.