Acute myelogenous leukemia in elderly patients not eligible for intensive chemotherapy: the dark side of the moon

Abstract

Our data outline the great heterogeneity of elderly AML patients not eligible for intensive CT. A simple scoring system including easily evaluable parameters, which could distinguish subjects with different prognosis, is proposed. Moreover, randomized studies in order to establish best conservative approaches are warranted.

Age and acute myeloid leukemia: real world data on decision to treat and outcomes from the Swedish Acute Leukemia Registry

“…Newer treatments are often studied in patients judged to be unfit for standard treatment, but this seems not validated comparing ages and PS distributions in those studies to ours. 18,20 One important piece of information in this report is the finding of improved early death rates with intensive treatment compared with palliation only. This was seen in all age groups and all PS levels.…”

“…10 In addition, data from few databases 1,[11][12][13] and several single-institution observation studies are available. [14][15][16][17][18][19] The lack of validated guidelines on the use of intensive treatment for elderly patients has led to individual and variable management of older AML patients but also created an opportunity to study new therapies for patients "unfit" for standard therapy. [20][21][22][23] With the use of the large and almost complete and, therefore, unselected Swedish National Acute Leukemia Registry, we here show that age has a strong prognostic impact also within the group of elderly and that common assumptions with strong implications for management are untrue.…”

Acute myeloid leukaemia in the elderly: a review

“…Rollig et al (2010) subdivided patients with intermediate-risk cytogenetics into two groups, good and adverse, and showed significant differences in 3-year OS for these cohorts. Other models have used combinations of cytogenetics, AHD, lactate dehydrogenase (LDH), leukocytosis, PS and comorbidities to predict OS in patients who receive induction chemotherapy (Ferrara & Mirto, 1996;Stasi et al, 1996;Wahlin et al, 2001;Gupta et al, 2005a;Latagliata et al, 2006;Gardin et al, 2007;Giles et al, 2007b) (Table II).…”

“…Multivariate predictors of TRM include PS, laboratory abnormalities and the presence of infections (Estey, 2007), while multivariate predictors for early death include PS, organ function, comorbidity indices, beta-2 microglobulin, LDH, leukocytosis and thrombocytopenia (Latagliata et al, 2006;Tsimberidou et al, 2008;Burnett et al, 2009). Multivariate predictors for disease resistance include cytogenetics, beta-2 microglobulin and PS (Albitar et al, 2007;Estey, 2008), and for OS include cytogenetics, age, luekocytosis, LDH, CD34-expression and NPM1 status (Rollig et al, 2010).…”

Heterogeneity in the therapeutic approach to relapsed elderly patients with acute myeloid leukaemia: a survey from the Gruppo Italiano Malattie Ematologiche dell' Adulto (GIMEMA) Acute Leukaemia Working Party

“…Moreover, in advanced age the frequency of the disease is expected to increase further in the years to come, given the progressive ageing of the general population. In contrast to the progress achieved in younger adults, the prognosis of AML arising in aged individuals remains poor and the current therapeutic results are largely unsatisfactory [4][5][6]. Following the administration of conventional induction chemotherapy (CHT), complete remission (CR) rates ranging from 40 to 60% are currently reported in AML of the elderly.…”