Acute myeloid leukemia in elderly patients: experience of a single center

Abstract

Acute myeloid leukemia (AML) is a disease predominantly of older adults. Treatment of AML in the elderly is complicated not only by comorbidities but also by the high prevalence of poor prognosis markers. Thirty-one consecutive unselected patients with AML older than 60 years (representing 33% of all AML cases diagnosed at our institution during the same period) were followed over a period of 5 years (1997)(1998)(1999)(2000)(2001)(2002). A high incidence of AML with multilineage dysplasia (45%) and no favorable cytogenetic abnormalities but 62% intermediate and 38% unfavorable karyotypes were found. Sixteen patients (52%) were selected for induction of intensive cytotoxic treatment and complete remission was achieved only by some of these intensively treated patients (7 of 16). Of these, 3 remained alive without disease (median: 11 months), 1 patient died shortly after complete remission, and 3 patients relapsed and died from refractory disease. Only 1 patient that was refractory to intensive cytotoxic treatment remained alive with disease under supportive care. Fifteen patients (48%) were managed with palliative/supportive care: 7 received palliative treatment and supportive care, 8 received supportive care only, and 4 patients remained alive with disease under supportive care (median: 9 months). Mortality rate was 74% and overall survival at two years was 12%. To the best of our knowledge, there is no previous report regarding elderly patients with AML in Brazilian subsets. The present data are similar to previously reported studies showing that elderly AML patients are not only older but also biologically distinct from younger AML patients, particularly in terms of the high incidence of poor prognostic karyotypes and resistance to therapy.

Increased Risk of Acute Myeloid Leukemia in Patients with <i>CYP</i>1<i>A</i>1 Polymorphisms

“…We did not find any specific correlation within karyotypes and gene polymorphisms but we may underestimate this association due to the number of patients analyzed. Curiously, regarding to our cytogenetic data distribution is similar to larger series published elsewhere [20][21][22]. Others found an association with therapy-related AML and genetic polymorphisms [7].…”

Characterization and analysis of the outcome of adults with acute myeloid leukemia treated in a Brazilian University hospital over three decades

“…Indeed, in Rio de Janeiro, during the same period there was an increase of people more than 60 years old, from 8.7% in the 1980's to 11.2% in the 1990's, and 12.8% in the 2000's (19). Furthermore, AML in the elderly is associated with several biological and clinical features, including a high frequency of co-morbidities and multilineage dysplasia, as observed in our cohort (20).…”

Improving the outcomes of elderly patients with acute myeloid leukemia in a Brazilian University Hospital

“…The treatment of elderly AML patients is challenging, with poor response rates and high mortality rates following intensive chemotherapy 3. A previous study from our group4 had similar findings, reporting an adverse outcome in AML patients older than 60 with no impact of intensive treatment on overall survival time.…”