Acute Myeloid Leukemia in the Elderly

Haema 2017; 8(2): 188-199

by Ιfigeneia A. Τzannou1 and Nicolaos Charchalakis2

1Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX, USA,
2Haematology – Lymphomas Department and BMT Unit, Evangelismos Hospital, Athens, Greece

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Abstract

More than half of the patients with newly diagnosed acute myeloid leukemia re over 65 years old. However, only 40% of these patients receive chemotherapy, even though treated patients have shown a significantly lower risk of death compared to untreated patients. Selecting the optimal treatment strategy is challenging. It should be based on the patient’s eligibility to receive intensive chemotherapy. The elderly experience increased toxicity and treatment-related mortality, which are due to both diseaseand patient-related characteristics. It is therefore important to assess patient fitness for induction therapy. A number of assessment tools have been developed to help estimate the treatment-related mortality and the chance of complete remission. Low risk patients will likely benefit from intensive induction chemotherapy and allogeneic stem cell transplant, if needed. High risk patients, on the other hand, should be treated with low intensity therapies or best supportive care. Although our understanding of AML in the elderly is now better and the treatment options have expanded, the outcomes remain poor, so that enrolment in clinical trials with novel, less toxic, agents should be considered for this group of patients.