Journal of Clinical Oncology, Vol 17, Issue 11
(November), 1999: 3569-3576
© 1999 American Society for Clinical Oncology
Management of Acute Myeloid Leukemia in Elderly Patients
Wolfgang Hiddemann,
Wolfgang Kern,
Claudia Schoch,
Christa Fonatsch,
Achim Heinecke,
Bernhard Wörmann,
Thomas Büchner
From the Department of Medicine III, University Hospital Großhadern, Munich, and Departments of Medicine A and Medical Informatics and Biomathematics, University of Münster, Münster, Germany, and Department of Medical Biology, University of Vienna, Vienna, Austria.
Address reprint requests to Wolfgang Hiddemann, MD, PhD, Univ.-Klinikum Großhadern, Medizinische Klinik III, Abt Hämatologie/Onkologie, Marchioninistrasse 15, 81377 München, Germany.
ABSTRACT: Acute myeloid leukemia (AML) at older age is associated with several biologic and clinical characteristics. Hence, it may arise from an early level of hematopoietic stem cells and has a high frequency of blast cells with multidrug resistance glycoprotein MDR1 expression and particularly a high incidence of poor prognostic karyotypes. These factors, rather than age per se, underlie the poorer outcome as compared with younger cases. Prospective randomized studies clearly demonstrate, however, that elderly patients benefit from more intensive induction therapy and particularly from full-dose application of anthracyclines and possibly also cytarabine. Hematopoietic growth factors accelerate the recovery from treatment-induced neutropenia and may improve the remission rate, remission duration, and even overall survival. New treatment strategies need to be developed, however, for poor-prognosis AML subtypes in order to further improve the therapeutic perspectives for elderly patients with AML.
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