New insights in the management of elderly patients with acute myeloid leukemia.
OBJECTIVE
The management of elderly patients with acute myeloid leukaemia (AML) is more than ever a challenge. Results associated with intensive chemotherapy remain disappointing, at least in nonselected patients. On the contrary, there are still no real standard alternatives even if some new approaches seem promising.


RESULTS
Recent studies aim to guide the selection of patients likely to benefit from intensive chemotherapy; to optimize remission induction and maintenance in those patients; and to evaluate long-term results associated with alternative therapies. Main results are the following: favorable AML subsets identified in younger patients remain favorable in elderly patients and might benefit from a relatively intensified treatment; if daunorubicin is used for induction, a dose higher than 45 mg/m2 x 3 results in a higher complete remission rate and longer survival, at least until 65 years of age; repeated intensive postremission courses do not seem to be effective in older patients; and median survival observed after clofarabine or azacitidine-based therapy could be long enough to deserve prospective comparisons against conventional chemotherapy.


CONCLUSIONS
These new results may help to offer a personalized management to elderly patients with AML and to design future trials.
Dombret
Hervé
H
Department of Clinical Hematology and Immunology, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, EA 3518 Université Paris 7, Paris, France. herve.dombret@sls.aphp.fr
Raffoux
Emmanuel
E
Gardin
Claude
C
D000208:Acute Disease; D000368:Aged; D006299:Health Services for the Aged; D006801:Humans; D007951:Leukemia, Myeloid / Q000628:therapy*; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D012074:Remission Induction