Conservative treatment for patients over 80 years with acute myelogenous leukemia.
In order to evaluate the best treatment of very elderly patients with AML, we have retrospectively analyzed 60 cases of patients aged more than 80 years, with a diagnosis of AML and observed from January 1988 to December 1998. Six of these patients were subsequently referred to other centers; of the remaining 54 patients, 20 (37%) received only supportive care, whereas 34 (63%) required palliative chemotherapy to control leukocytosis, after a median time from diagnosis of 9 days (range 0-253). Median overall survival was 13 weeks (range 1-105): 21 (39%) and 6 (11%) patients survived more than 6 and 12 months, respectively. Twenty-eight patients (51.8%) died from progressive disease, 19 (35.1%) died from AML-related or unrelated causes in the phase of stable disease, while in 7 patients the cause of death was unknown. In univariate analysis, PS > 2 and WBC > 50 x 10(9)/L had an adverse prognostic significance on survival. Our results, as compared with those reported in the literature for patients over 80 years treated with intensive chemotherapy, support the idea that intensive chemotherapy is usually not indicated in very elderly patients with AML, and that conservative treatment and the primary strategy of "watch-and-wait" presently seems to be the best choice.
Latagliata
Roberto
R
Dipartimento di Biotecnologie Cellulari ed Ematologia, University La Sapienza of Rome. rob.lati@libero.it
Alimena
Giuliana
G
Carmosino
Ida
I
Breccia
Massimo
M
Borza
Paola Anticoli
PA
Bongarzoni
Velia
V
Copia
Carolina
C
Spadea
Antonio
A
Pinazzi
Beatrice
B
Frattarelli
Natalia
N
Ferrara
Felicetto
F
Petti
Maria Concetta
MC
Mandelli
Franco
F
D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy*; D008297:Male; D010166:Palliative Care; D012189:Retrospective Studies
D000970:Antineoplastic Agents