Acute myeloid leukemia in elderly adults

Abstract

One hundred and fifteen previously untreated adults aged over 60 years were referred to St Bartholomew's Hospital between 1978 and 1986 for management of acute myeloid leukemia (AML). Twenty-seven patients received symptomatic or palliative treatment only because combination chemotherapy was considered inappropriate. Eighty-eight patients received intensive chemotherapy with curative intent. There was a 48 per cent 'early death' rate and a 24 per cent incidence of resistant disease; complete remission (CR) was achieved in 25/88 patients (28 per cent). By multivariate analysis, a blast count less than 50 x 10(9)/l at presentation was the only factor predictive for achievement of CR whilst the latter and a presentation blast count less than 50 x 10(9)/l predicted for superior survival. Treatment was often curtailed on account of unacceptable toxicity; only 2/88 patients received the planned six cycles of treatment. Two patients died in CR. Four patients are alive in first CR at 3-9 years from treatment; one is alive in second CR following meningeal relapse. Overall survival was significantly worse than that of a contemporaneous group of adults aged 15-59 years treated at this hospital, but duration of CR was comparable. There are great difficulties involved in the intensive treatment of AML in elderly adults, but the major survival benefit gained by achieving CR should stimulate the search for better tolerated but still curative regimens.

Treating octogenarian and nonagenarian acute myeloid leukemia patients—Predictive prognostic models

“…Similarly, in 3 retrospective studies, [25][26][27] longer survival was reported for intensively treated patients compared with supportively treated patients, although all of those studies included only a few patients aged !75 years. Conversely, our results are in line with 3 other retrospective studies, [28][29][30] which demonstrated only a marginal, if any, advantage in OS for intensively treated patients. Finally, our study included the largest number octogenarian and nonagenarian patients.…”

Early blast clearance by remission induction therapy is a major independent prognostic factor for both achievement of complete remission and long-term outcome in acute myeloid leukemia: data from the German AML Cooperative Group (AMLCG) 1992 Trial

“…a hyperleukocytosis has been identified to be associated with a higher early death rate and an inferior OS. [40][41][42][43][44] These associations have been confirmed in some multivariate analyses. [45][46][47][48] In contrast, there are only a few studies addressing issues similar to those in the present analysis.…”

Acute promyelocytic leukaemia: a retrospective analysis of patients treated at St. Bartholomew's Hospital 1969-1995

“…This strategy was adapted in 1985, and a maximum of four cycles of treatment were subsequently administered. Since 1986, patients over the age of 60 years have received treatment with either mAMSA and ara-C or mitoxantrone and ara-C [32,49].…”