title: Survival of elderly patients with acute myeloid leukemia.
abstract: OBJECTIVE
  The prognosis of elderly patients with acute myelogenous leukemia (AML) is usually dismal, while the true survival of older patients not included in clinical trials is not known. We retrospectively evaluated the impact on survival of an aggressive versus a non-aggressive approach in 1005 patients aged >60 years registered in the database of the GIMEMA cooperative group.
  
  
  METHODS
  Group A patients (n=621) received aggressive treatment, while group B patients (n=384) underwent non-aggressive therapy. The groups were different for risk factor distribution: the patients in group B had a higher median age, worse performance status (PS) and a higher proportion of previous myelodysplastic disease.
  
  
  RESULTS
  The overall median survival was 7 and 5 months in groups A and B, respectively (p min of 0.0001). At multivariate analysis the following factors were associated with a significantly shorter survival: age >71 years (RR=1.27; 95% CI=1.07-1.50), PS=2-4 (RR=1.44; 95% CI=1.24-1.68), white cell count > 10,000 mL (RR=1.37; 95% CI=1.06-1.75), and heart dysfunction requiring treatment (RR=1.26; 95% CI=1.05-1.50). No difference in survival was associated with aggressive or non-aggressive treatment (RR=1.1; 95% CI=0.94-1.32). Patients aged min of 70 years, with no heart disease, but a white cell count > 10,000/mL showed a significantly better survival when treated aggressively (median survival 7 vs 3 months, p = 0.011).
  
  
  CONCLUSIONS
  Despite an obvious selection of patients with a worse prognosis in group B, the difference in survival between the two groups was marginal. Multivariate analysis failed to demonstrate a significant survival benefit in aggressively treated patients. All these considerations indicate that elderly patients with AML are overall unlikely to benefit from aggressive treatment, so that this should be offered only to selected patients.
authors.affiliation: Dpt. of Cellular Biotechnology and Hematology, La Sapienza University, Roma, Italy. pulsoni@bce.uniroma1.it
authors.forename: Alessandro
authors.initials: A
authors.lastname: Pulsoni
authors.forename: Livio
authors.initials: L
authors.lastname: Pagano
authors.forename: Roberto
authors.initials: R
authors.lastname: Latagliata
authors.forename: Marco
authors.initials: M
authors.lastname: Casini
authors.forename: Raffaella
authors.initials: R
authors.lastname: Cerri
authors.forename: Monica
authors.initials: M
authors.lastname: Crugnola
authors.forename: Lorella
authors.initials: L
authors.lastname: De Paoli
authors.forename: Eros
authors.initials: E
authors.lastname: Di Bona
authors.forename: Rosangela
authors.initials: R
authors.lastname: Invernizzi
authors.forename: Filippo
authors.initials: F
authors.lastname: Marmont
authors.forename: Maria Concetta
authors.initials: MC
authors.lastname: Petti
authors.forename: Gianmatteo
authors.initials: G
authors.lastname: Rigolin
authors.forename: Francesca
authors.initials: F
authors.lastname: Ronco
authors.forename: Antonio
authors.initials: A
authors.lastname: Spadano
authors.forename: Maria Elena
authors.initials: ME
authors.lastname: Tosti
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Visani
authors.forename: Alfonso
authors.initials: A
authors.lastname: Mele
authors.forename: Franco
authors.initials: F
authors.lastname: Mandelli
mesh_terms: D000208:Acute Disease; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D006801:Humans; D007951:Leukemia, Myeloid / Q000188:drug therapy / Q000401:mortality*; D011379:Prognosis; D012074:Remission Induction; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome