title: Treatment of older patients with AML.
abstract: Undertreatment of the older patients with AML can explain, in part, their inferior outcome when compared with that in younger patients. In analogy to the benefit of patients under the age of 60 years from high-dose AraC there are dosage related therapeutic effects in the patients over 60 years in particular for daunorubicin in the induction treatment, and for maintenance versus no maintenance in the post-remission treatment. Utilizing these effects can partly overcome the mostly unfavorable disease biology in older age AML, whereas the role of risk factors involved is not completely understood and the concept of dose-response needs to be requestioned. We recommend an adequate dosage of 60 mg/(m2day) daunorubicin for 3 days in a combination with standard dose AraC and 6-thioguanine given for induction and consolidation and followed by a prolonged monthly maintenance chemotherapy. Further improvements in supportive care may help delivering additional anti-leukemic cytotoxicity. As a novel approach, reduced toxicity preparative regimens may open up allogeneic transplantation for older patients with AML. Other new options like MDR modulators, antibody targeted therapies and tyrosine kinase inhibitors 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 decreasing quality of life. This finding did not vary by age under or above 60 years. Given the actual median age in this disease being more than 60 years the adequate management of older age AML remains as the major challenge.
authors.affiliation: University Hospital, Department of Medicine, Hematology and Oncology, Albert-Schweitzer-Str. 33, D-48129 Münster, Germany. buechnr@uni-muenster.de
authors.forename: Thomas
authors.initials: T
authors.lastname: Büchner
authors.forename: Wolfgang E
authors.initials: WE
authors.lastname: Berdel
authors.forename: Bernhard
authors.initials: B
authors.lastname: Wörmann
authors.forename: Claudia
authors.initials: C
authors.lastname: Schoch
authors.forename: Torsten
authors.initials: T
authors.lastname: Haferlach
authors.forename: Susanne
authors.initials: S
authors.lastname: Schnittger
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Kern
authors.forename: Carlo
authors.initials: C
authors.lastname: Aul
authors.forename: Eva
authors.initials: E
authors.lastname: Lengfelder
authors.forename: Andrea
authors.initials: A
authors.lastname: Schumacher
authors.forename: Albrecht
authors.initials: A
authors.lastname: Reichle
authors.forename: Peter
authors.initials: P
authors.lastname: Staib
authors.forename: Leopold
authors.initials: L
authors.lastname: Balleisen
authors.forename: Hartmut
authors.initials: H
authors.lastname: Eimermacher
authors.forename: Andreas
authors.initials: A
authors.lastname: Grüneisen
authors.forename: Herbert
authors.initials: H
authors.lastname: Rasche
authors.forename: Maria Cristina
authors.initials: MC
authors.lastname: Sauerland
authors.forename: Achim
authors.initials: A
authors.lastname: Heinecke
authors.forename: Rolf M
authors.initials: RM
authors.lastname: Mesters
authors.forename: Hubert L
authors.initials: HL
authors.lastname: Serve
authors.forename: Joachim
authors.initials: J
authors.lastname: Kienast
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Hiddemann
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000911:Antibodies, Monoclonal / Q000008:administration & dosage; D000970:Antineoplastic Agents / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D003561:Cytarabine / Q000008:administration & dosage; D003630:Daunorubicin / Q000008:administration & dosage; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000401:mortality / Q000628:therapy*; D008875:Middle Aged; D047428:Protein Kinase Inhibitors / Q000008:administration & dosage; D012074:Remission Induction; D033581:Stem Cell Transplantation; D013866:Thioguanine / Q000008:administration & dosage; D014184:Transplantation, Homologous
chemical_list: D000911:Antibodies, Monoclonal; D000970:Antineoplastic Agents; D047428:Protein Kinase Inhibitors; D003561:Cytarabine; D013866:Thioguanine; D003630:Daunorubicin