Treatment of acute myeloid leukemia with antecedent myelodysplastic syndrome.
Primary myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML) are both age-related, with increasing prevalence over age 60. The poor outcome of treatment for elderly AML patients is due both to host-related and intrinsic biologic factors. Some elderly patients have documented MDS for months or years before presenting with AML. Many more, though, have dysplastic morphology in bone marrow and blood cells that suggests an occult preleukemic phase. Cytotoxic chemotherapy in elderly patients has a high morbidity and mortality due to comorbid diseases, diminished tolerance to prolonged pancytopenia, and decreased drug metabolism and excretion; doses, therefore, are often attenuated. The low response rates to conventional remission-induction chemotherapy regimens suggest both intrinsic drug resistance and diminished normal hematopoietic precursors to regenerate following therapy. Less intensive chemotherapy has the potential for less organ toxicity, less hospitalization, and less expense. However, attenuated chemotherapy has the major disadvantage of less antileukemic activity and, as yet, the survival benefit for this approach remains unproven. Nevertheless, low-dose ara-C (cytarabine) therapy for 2 to 3 weeks may be beneficial for some patients. The standard response criteria used with acute leukemia to measure disease eradication may not be appropriate for patients with MDS evolving to AML.
Larson
R A
RA
Department of Medicine, University of Chicago Pritzker School of Medicine, Il 60637-1463, USA.
D000208:Acute Disease; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D003561:Cytarabine / Q000627:therapeutic use*; D006801:Humans; D007951:Leukemia, Myeloid / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality / Q000473:pathology; D008875:Middle Aged; D009017:Morbidity; D009190:Myelodysplastic Syndromes / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality / Q000473:pathology; D015996:Survival Rate
D000970:Antineoplastic Agents; D003561:Cytarabine