title: Improving the outcomes of elderly patients with acute myeloid leukemia in a Brazilian University Hospital.
abstract: OBJECTIVE
  To evaluate the outcomes of acute myeloid leukemia patients who were older than 60 years of age at the time of diagnosis following the implementation of a treatment algorithm based on age, performance status, and cytogenetic results.
  
  
  METHODS
  We retrospectively compared the results of 31 elderly acute myeloid leukemia patients (median age of 74 years) who were treated according to the new algorithm.
  
  
  RESULTS
  Fifteen patients with a good performance status and no unfavorable karyotypes were treated with either intensive cytotoxic chemotherapy (<70 years, nine cases) or adapted etoposide, 6-thioguanine and idarubicine (>70 years, six cases); 16 cases with a poor performance status or unfavorable cytogenetics received supportive care only. Six patients achieved a complete remission and two achieved a partial remission after chemotherapy. There were three toxic deaths during induction, two in the adapted etoposide, 6-thioguanine and idarubicine group and one in the intensive cytotoxic chemotherapy group. The overall median survival time was 2.96 months, 1.3 months in the supportive care group, and 4.6 months in the treatment group.
  
  
  CONCLUSIONS
  Our results illustrate the importance of treatment guidelines adapted to local resources in an attempt to improve the survival of elderly acute myeloid leukemia patients in developing countries.
authors.affiliation: Disciplina de Hematologia e Hemoterapia, UNIFESP - Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo/SP, Brazil. alex.sandes@bol.com.br
authors.forename: Alex Freire
authors.initials: AF
authors.lastname: Sandes
authors.forename: Juliana Correa da Costa
authors.initials: JC
authors.lastname: Ribeiro
authors.forename: Rodrigo S
authors.initials: RS
authors.lastname: Barroso
authors.forename: Maria R R
authors.initials: MR
authors.lastname: Silva
authors.forename: Maria L L F
authors.initials: ML
authors.lastname: Chauffaille
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001938:Brazil; D020732:Cytogenetic Analysis; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D006785:Hospitals, University; D006801:Humans; D015255:Idarubicin / Q000008:administration & dosage; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy* / Q000235:genetics / Q000401:mortality; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D011379:Prognosis; D012189:Retrospective Studies; D013866:Thioguanine / Q000008:administration & dosage; D016896:Treatment Outcome
chemical_list: D005047:Etoposide; D013866:Thioguanine; D015255:Idarubicin