[Elderly patients with acute myeloid leukemia: characteristics in biology, patients, and treatment]

The incidence rate of acute myeloid leukemia (AML) is increasing with age, the 5-year survival rates of the patients, however, are decreasing in an age-dependent manner. BIOLOGY AND PATIENTS: Patients with AML are considered to be old, if they have reached an age of > or =60. This is due to patient- and disease-associated parameters, which reveal differences between older and younger patients with AML, but the cutoff is arbitrary.

Standard treatment is a dose-intensive chemotherapy for induction of complete remission, followed by different kinds of post-remission therapies. A small percentage of patients can be cured by this approach. The main group of patients, however, will die within the first 2 years after diagnosis due to the disease or therapy-related complications. The improvements in the treatment of patients with AML over the last few years are mainly restricted to the group of younger patients. Due to the small percentage of patients who are cured and the high rate of treatment-related mortality in elderly patients with AML the question arises, which patients benefit from a primary curative approach, and which patients are to be treated primarily with a palliative therapy. The value of a palliative approach has not yet been consistently validated within clinical trials. Therefore a geriatric assessment will be an important tool within clinical trials for elderly patients with AML.

New classes of drugs, such as inhibitors of signal transduction, monoclonal antibodies and inhibitors of angiogenesis, or allogenic blood steam cell therapy after nonmyeloablative conditioning regimens might improve therapy in the near future.