Acute Myelogenous Leukemia in the Elderly

Ballester, Oscar F.; Moscinski, Lynn C.; Morris, D.; Balducci, Lodovico

doi:10.1111/j.1532-5415.1992.tb02083.x

Cited by 13 publications

(6 citation statements)

References 75 publications

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“…31 However, these conclusions have not remained uncontested. 32,33 Although AML in older adults is far from being a homogeneous entity, there appears to be an increased frequency of less differentiated leukemias, whether diagnosed by morphologic criteria 34 or by antigenic characteristics such as an increased frequency of CD34 expression. 35 Conversely, AML with FAB-type M0, the subtype with the least morphologic differentiation, 12 develops preferentially in older patients (Z60 years of age).…”

Section: Discussionmentioning

confidence: 99%

Low expression of the myeloid differentiation antigen CD65s, a feature of poorly differentiated AML in older adults: study of 711 patients enrolled in ECOG trials

et al. 2003

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CD65s appears when the progenitor antigen CD34 disappears, suggesting that this sialylated carbohydrate antigen marks a turning point in normal myeloid differentiation. We characterized acute myeloid leukemia (AML) with low CD65s expression (CD65s low AML) in 711 patients entered on seven Eastern Cooperative Oncology Group AML treatment trials (1986)(1987)(1988)(1989)(1990)(1991)(1992)(1993)(1994)(1995)(1996)(1997)(1998)(1999). Of those, 198 (28%) qualified as having CD65s low AML. Morphologically, CD65s low AML was more common in FAB subgroups with minimal differentiation, M0/M1 (P ¼ o0.0001). Early precursor antigens CD34, CD117 and terminal transferase were more frequent in CD65s low than CD65s high AML (P ¼ o0.0001). Myeloperoxidase was present in fewer CD65s low myeloblasts, and the more mature myeloid antigens, CD15 and CD11b, were rarely detected (P ¼ o0.0001). Yet, the two diagnoses did not differ in the distribution of cytogenetic prognostic groups or the occurrence of the multidrug-resistance mediator, P-glycoprotein. CD65s low AML patients were significantly older than CD65s high cases (Po0.0001). Furthermore, the incidence of CD65s low cases increased with age, from 20% in patients under the age of 50 years to 67% in patients older than 80 years (Po0.0001). Overall, complete remission (CR) rate and overall survival were comparable in CD65s low and CD65s high AML. However, among patients 455 years of age, CD65s low AML had a decreased CR rate of 33 vs 44% in CD65s high AML (P ¼ 0.055). Thus, CD65s low AML represents immunophenotypically undifferentiated disease and occurs predominantly in older adults. Although not statistically significant, the observed association between low CD65s expression and decreased CR rate only in patients over the age of 55 is intriguing.

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Section: Discussionmentioning

confidence: 99%

Low expression of the myeloid differentiation antigen CD65s, a feature of poorly differentiated AML in older adults: study of 711 patients enrolled in ECOG trials

et al. 2003

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“…42% of patients over 55 years of age with acute myelogenous leukaemia Drugs & Aging 4 (4) 1994 and more than 30% of those over 60 years with advanced ovarian cancer live for 3 years or longer (Balducci et al 1994;Ballester et al 1992;Rowe et al 1993).…”

Section: Cancer Chemotherapy: a Decisional Modelo/qolmentioning

confidence: 98%

“…For example, the prognosis of acute myelogenous leukaemia worsens after age 60 years (Ballester et al 1992), and the prognosis of breast cancer after age 75 years (Silliman et al 1993). …”

Section: Aging and Cancer: Clinical Interactionsmentioning

confidence: 99%

“…Since the effectiveness of chemotherapy decreases with increasing age in patients with acute leukaemia, malignant lymphoma and ovarian cancer (Balducci et al 1994), it is reasonable to assume an increased prevalence of multidrug resistance. The P-glycoprotein, which represents and effects multidrug resistance, was demonstrated on the cellular and nuclear membranes of 60% of neoplastic cells in myelodysplastic syndromes, which may precede acute myelogenous leukaemia in older persons (Ballester et al 1992).…”

Section: Pharmacological Changes Associated With Agementioning

confidence: 99%

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Perspectives on Quality of Life of Older Patients with Cancer

Balducci

1994

Drugs & Aging

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Cancer in older people is an increasingly common problem. Since survival benefits may decline and the risks of treatment progressively increase with age, preservation and improvement of quality of life (QOL) is a major goal of geriatric oncology. The concept of health-related QOL holds that the preservation of health and physical function is necessary to the maintenance and improvement of QOL, and encompasses several constructs, including physical, functional, emotional, social, and spiritual domains. Several instruments for the assessment of QOL have been validated, but none has been calibrated to the special problems of older people. Such problems involve diverse evolution of health and disease around variable models, potential age-related shifts in values and focus, and barriers to the use of questionnaires, such as poor visual and auditory function, easy fatiguability, slower reactions and dementia. Individualised questionnaires may represent the ultimate goal in the assessment of QOL in the elderly. The assessment of QOL in general oncology has provided new and important information related to the value of breast preservation in the management of breast cancer, to the value of sexual function in the management of prostate cancer, and to the effects of limb amputation on QOL. Also, QOL at the beginning of treatment has independent prognostic implications. In geriatric oncology, assessment of QOL may allow trade-off between QOL and survival, and may determine the choice among alternative forms of life-prolonging and palliative treatments.

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“…in the pharmacokinetic (PK) characteristics of the drug, as well as in the individual responses to the drugs, i.e. in their pharmacodynamic (PD) effects [13][14][15][16][17]. These modifications of drug PK and PD in the elderly can lead to either lack of efficacy or excessive toxicity.…”

Section: Introductionmentioning

confidence: 99%