Older adults: should the paradigm shift from standard therapy?
For older adults (ie, those age 60 and above) with acute myelogenous leukemia, patient and clinician have three choices: standard therapy, ie, a "3+7" regimen or low-dose ara-C, investigational therapy, or palliative care. Investigational treatments sponsored by pharmaceutical companies tend to exclude the 10-20% of older patients who have a poor performance status (Zubrod >2), an increased bilirubin, or creatinine (>1.9 mg/ml) and who are thereby unlikely to do well with standard therapy. However, even excluding such patients, standard treatment offers little obvious benefit for most older patients. Nonetheless, these older patients are not uniform and can be stratified to receive investigational therapy, which is mandatory for most, or standard therapy, which is not inappropriate for some.
Estey
Elihu H
EH
Section of Acute Leukemia and Myelodysplastic Syndrome, Division of Cancer Medicine, MD Anderson Cancer Center, Box 428, 1515 Holcombe Boulevard, Houston, TX 77030, USA. eestey@mdanderson.org
D000367:Age Factors; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood; D002986:Clinical Trials as Topic; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000145:classification / Q000188:drug therapy*; D008875:Middle Aged; D010347:Patient Care Planning; D012074:Remission Induction / Q000379:methods; D035703:Therapies, Investigational; D001613:beta 2-Microglobulin / Q000097:blood
D015415:Biomarkers; D001613:beta 2-Microglobulin