Acute myelogenous leukemia (AML) is generally looked upon as a heterogeneous group of different entities originating from the malignant transformation of a hematopoietic progenitor or stem cell. AML incidence increases with age. AML is associated with a poor prognosis, particularly in older patients. The poor prognosis in older adults is because of a combination of factors, including a larger proportion of cases with adverse-risk cytogenetics and other deleterious genetic and epigenetic changes, lower rates of achieving complete remission with intensive chemotherapy, higher risk of disease recurrence after achieving remission, greater comorbidity, inability to tolerate conventional allogeneic bone marrow transplantation regimens, and other adverse prognostic factors. The outlook for these patients remains dismal and little progress as been made in the last two decades. Current treatment of elderly AML consists of intensive chemotherapy with an anthracycline and a cytarabine. To evaluate our progress in the diagnosis, treatment and outcome of this condition, we reviewed the reports of 93 newly diagnosed acute myeloid leukaemia patients>/=55 years of age admitted to our department between 2003 and 2007.
A retrospective chart review was performed of 93 patients >/=55 years of age diagnosed with acute myeloid leukemia. The clinical efficacy was observed and the overall survival(OS) were analyzed.
Median age of patients was 66 (range 55-88) years, 69 patients(74%) received a combination of an anthracycline and a cytarabine, either mitoxantrone per day on days 1, 2(MA),or 35 mg/m2 pirarubicin(TA) 7–8mg/m2 or idarubicin per day on days 1, 2 (IA). Each patient was given 100mg/m2 cytarabine intravenously per day for 7 days. And 24 patients (26%) were untreated. Total CR rate was 45% after 2 regimens. Only 3 patients happened to early death. The median period of the bone marrow depression is 19 days. The follow-up was ended at Aug 2008 year. Median survival of the treated patients was 256 days and it was significantly (P = 0.003) different from the untreated patients(66 days). Of the treated group, 7 patients were still alive, and the longest time was more than 6 years.
The prognosis of acute myeloid leukemia in older patients remains poor, but the anthracycline chemotherapy seems to improve the outcomes among older with AML. For this difficult patient cohort, it is a better treatment that can exert a more selective anti-leukaemic activity whilst not suppressing normal haemopoiesis or having significant systemic toxicities.
No relevant conflicts of interest to declare.
Asterisk with author names denotes non-ASH members.