title: Acute myeloid leukemia: treatment over 60.
abstract: Undertreatment of older patients with acute myeloid leukemia (AML) can explain, in part, their inferior outcome when compared to that of younger patients. In agreement with the benefit seen by patients under age 60 from high-dose cytosine arabinoside (Ara-C), there are dose effects in the over 60s, in particular for daunorubicin, in induction treatment and for the duration of postremission treatment. The use of these effects can partly overcome the mostly unfavorable disease biology in older age AML, as expressed by the absence of favorable and the over-representation of adverse chromosomal abnormalities as well as the expression of drug resistance. We recommend an adequate dosage of 60 mg/m2 daunorubicin on 3 days in combination with standard dose Ara-C and 6-thioguanine given for induction and consolidation, and followed by a prolonged monthly maintenance chemotherapy for at least 1 year's duration. Further improvements in supportive care may help to deliver additional antileukemic cytotoxicity. As a novel approach, nonmyeloablative preparative regimens may open up the possibility of allogeneic transplantation for older patients with AML. Other new options like multidrug resistance modulators, antibody targeted therapies and molecular targeting are under clinical investigation. A questionnaire study in patients with AML showed that, according to patients' self-assessment, intensive and prolonged treatment did not result in a diminished quality of life. This finding did not vary by age, under or over 60 years. As the median age in this disease is more than 60 years, the adequate management of AML in older patients remains the major challenge.
authors.affiliation: University of Münster, Department of Medicine, Hematology and Oncology, Germany. buechnr@uni-muenster.de
authors.forename: Thomas
authors.initials: T
authors.lastname: Büchner
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Hiddemann
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Berdel
authors.forename: Bernhard
authors.initials: B
authors.lastname: Wörmann
authors.forename: Claudia
authors.initials: C
authors.lastname: Schoch
authors.forename: Helmut
authors.initials: H
authors.lastname: Löffler
authors.forename: Torsten
authors.initials: T
authors.lastname: Haferlach
authors.forename: Andrea
authors.initials: A
authors.lastname: Schumacher
authors.forename: Peter
authors.initials: P
authors.lastname: Staib
authors.forename: Leopold
authors.initials: L
authors.lastname: Balleisen
authors.forename: Andreas
authors.initials: A
authors.lastname: Grüneisen
authors.forename: Herbert
authors.initials: H
authors.lastname: Rasche
authors.forename: Carlo
authors.initials: C
authors.lastname: Aul
authors.forename: Axel
authors.initials: A
authors.lastname: Heyll
authors.forename: Eva
authors.initials: E
authors.lastname: Lengfelder
authors.forename: Wolf-Dieter
authors.initials: WD
authors.lastname: Ludwig
authors.forename: Georg
authors.initials: G
authors.lastname: Maschmeyer
authors.forename: Hartmut
authors.initials: H
authors.lastname: Eimermacher
authors.forename: Jochen
authors.initials: J
authors.lastname: Karow
authors.forename: Norbert
authors.initials: N
authors.lastname: Frickhofen
authors.forename: Wolf-Dietrich
authors.initials: WD
authors.lastname: Hirschmann
authors.forename: Maria-Cristina
authors.initials: MC
authors.lastname: Sauerland
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D018380:Hematopoietic Stem Cell Transplantation / Q000401:mortality; D006801:Humans; D007951:Leukemia, Myeloid / Q000401:mortality / Q000628:therapy*; D008875:Middle Aged; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents