title: De novo acute myeloid leukemia in the elderly; a consistent fraction of long-term survivors by standard-dose chemotherapy.
abstract: To clarify the characteristics of de novo acute myeloid leukemia (AML) among the elderly, we reviewed 112 patients over 60 years old (median age 72 years) who were treated at hospitals in Nagasaki Prefecture with a population of 1.5 million between 1987 and 1994. Reclassification of morphological diagnosis revealed that the proportion of M3 was lower but that of M6 and the incidence of cases with trilineage dysplasia (TLD), known as poor prognostic features, were higher in the elderly than in patients less than 60 years old. Similarly, chromosomal data showed a lower frequency of favorable karyotypes such as t(8;21) and t(15;17) in the elderly. The overall survival of all 112 patients was 10.3% at 5 years. Multivariate analysis indicated that good performance status (PS), low WBC at diagnosis, standard dose multi-drug chemotherapy and all-trans retinoic acid (ATRA) treatment for M3 patients, and morphological findings without TLD were significantly correlated with longer survival. Most of the long-term survivors were found among those who received standard dose therapy in this series, although no consensus has been established how to treat elderly AML patients. We propose that a prospective controlled trial is necessary to confirm the role of standard dose chemotherapy for elderly patients with de novo AML.
authors.affiliation: Department of Hematology and Molecular Medicine Unit, Atomic Bomb Disease Institute, Nagasaki University School of Medicine, Sakamoto 1-12-4, Nagasaki 852-8523, Japan.  
authors.forename: S
authors.initials: S
authors.lastname: Yoshida
authors.forename: K
authors.initials: K
authors.lastname: Kuriyama
authors.forename: Y
authors.initials: Y
authors.lastname: Miyazaki
authors.forename: J
authors.initials: J
authors.lastname: Taguchi
authors.forename: T
authors.initials: T
authors.lastname: Fukushima
authors.forename: M
authors.initials: M
authors.lastname: Honda
authors.forename: T
authors.initials: T
authors.lastname: Hayashibara
authors.forename: K
authors.initials: K
authors.lastname: Nagai
authors.forename: S
authors.initials: S
authors.lastname: Atogami
authors.forename: K
authors.initials: K
authors.lastname: Toriya
authors.forename: H
authors.initials: H
authors.lastname: Soda
authors.forename: H
authors.initials: H
authors.lastname: Nonaka
authors.forename: S
authors.initials: S
authors.lastname: Momita
authors.forename: I
authors.initials: I
authors.lastname: Jinnai
authors.forename: T
authors.initials: T
authors.lastname: Amenomori
authors.forename: M
authors.initials: M
authors.lastname: Kusano
authors.forename: Y
authors.initials: Y
authors.lastname: Yoshida
authors.forename: S
authors.initials: S
authors.lastname: Ikeda
authors.forename: T
authors.initials: T
authors.lastname: Matsuo
authors.forename: M
authors.initials: M
authors.lastname: Tomonaga
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000473:pathology*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D003561:Cytarabine / Q000008:administration & dosage; D003630:Daunorubicin / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007621:Karyotyping; D007951:Leukemia, Myeloid / Q000145:classification / Q000188:drug therapy* / Q000235:genetics / Q000401:mortality; D008297:Male; D015122:Mercaptopurine / Q000008:administration & dosage; D008875:Middle Aged; D011379:Prognosis; D016896:Treatment Outcome; D014212:Tretinoin / Q000008:administration & dosage
chemical_list: D003561:Cytarabine; D014212:Tretinoin; D015122:Mercaptopurine; D003630:Daunorubicin