Treatment of older patients with AML.
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.
Büchner
Thomas
T
University Hospital, Department of Medicine, Hematology and Oncology, Albert-Schweitzer-Str. 33, D-48129 Münster, Germany. buechnr@uni-muenster.de
Berdel
Wolfgang E
WE
Wörmann
Bernhard
B
Schoch
Claudia
C
Haferlach
Torsten
T
Schnittger
Susanne
S
Kern
Wolfgang
W
Aul
Carlo
C
Lengfelder
Eva
E
Schumacher
Andrea
A
Reichle
Albrecht
A
Staib
Peter
P
Balleisen
Leopold
L
Eimermacher
Hartmut
H
Grüneisen
Andreas
A
Rasche
Herbert
H
Sauerland
Maria Cristina
MC
Heinecke
Achim
A
Mesters
Rolf M
RM
Serve
Hubert L
HL
Kienast
Joachim
J
Hiddemann
Wolfgang
W
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
D000911:Antibodies, Monoclonal; D000970:Antineoplastic Agents; D047428:Protein Kinase Inhibitors; D003561:Cytarabine; D013866:Thioguanine; D003630:Daunorubicin