Blood and marrow transplantation in elderly acute myeloid leukaemia patients - older certainly is not better.
Acute myeloid leukaemia in the elderly is a disease with distinct biological properties, commonly associated with leukaemic cell treatment resistance and with an increased number of high-risk features, including concomitant myelodysplasia and poor-risk cytogenetic abnormalities such as monosomy 5 and 7. Complete remission rates after standard induction chemotherapy in patients above age 60 years are less than 50%, with long-term survival rates below 10%. Post-remission stem cell transplant therapies have not been studied extensively. Autologous transplants can result in an acceptable 3-year leukaemia-free survival rate of up to 47%, yet this procedure is applicable only to a small minority of patients. Myeloablative allogeneic transplants similarly show feasibility in selected few patients and in general are very toxic. Non-myeloablative allogeneic transplants are associated with reduced toxicity, but are plagued by an increased relapse rate. The latter strategy appears promising, but must be validated in larger, multi-centre prospective trials, in which outcomes are compared to non-transplant approaches.
Kiss
T L
TL
Department of Hematology, Maisonneuve Rosemont Hospital, University of Montreal, Montreal, Quebec, Canada. thomas.kiss@umontreal.ca
Sabry
W
W
Lazarus
H M
HM
Lipton
J H
JH
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods; D006801:Humans; D007951:Leukemia, Myeloid / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy*; D008875:Middle Aged; D019172:Transplantation Conditioning / Q000379:methods; D016896:Treatment Outcome