Survival in Acute Leukemia in Elderly Patients

Abstract

Acute leukemia is more common in older people than in the young or middle-aged. However, the possibilities of achieving remission or prolonging survival are both inversely correlated with increasing age. We studied survival in 118 acute leukemia patients over the age of 64 seen at a university hospital from 1970 to 1987. Seventy percent had myeloid morphology. Median survival times were 106 days in those diagnosed in the 1970s and 71 days for those diagnosed in the 1980s. This was little changed from an earlier series from the same hospital extending back to the 1940s in which median survival was 69 days. Considering the two decades separately, age at diagnosis, sex, race, type of leukemia, and whether or not disease-specific treatment was applied had no significant effect on survival duration. Acute leukemia in the older patient demands difficult medical and ethical choices. Supportive therapy provides immediate comfort and relatively limited morbidity with certainty of death within a few months. Disease-specific therapy causes immediate morbidity for all, shortened life for the majority, and extended life for the minority.

Has the prognosis of adult patients with acute myeloid leukemia improved over years? A single institution experience of 784 consecutive patients over a 16-year period

“…12 Whether or not elderly AML patients' outcome has improved over the years is still controversial. [24][25][26] AML is a heterogeneous disease and therapeutic attitudes vary from intensive induction/post-remission treatments to palliative care according to presentation and disease course. Most of the publications on AML treatment report results of clinical trials and deal with selected patient populations, selection being based on age, performance status and/or preexisting myeloproliferative or myelodysplastic syndrome.…”

Palliative Therapies in Elderly Cancer Patients

“…Recent progress in treatment has been confined to young patients and children. [59,60) It can be deduced from these data that the goal of treatment should be cure in the first 2 groups, but is not a realistic goal of treatment in adults following relapse of the disease.…”

Treatment of acute myeloid leukemia in the elderly with low‐dose cytarabine, hydroxyurea, and calcitriol

“…However, 40% of patients with AML are over the age of 65 years. These patients have a significantly worse treatment outcome with median survival often limited to several weeks [4,5]. Many elderly patients have intercurrent medical problems and cannot tolerate the side effects of intensive therapy.…”