[Treatment of acute myeloblastic leukemia in aged patients]

Approximately 55 per cent of patients with acute myelogenous leukaemia (AML) are over 60 years of age, which raises therapeutic problems since the intensive chemotherapy generally used in younger patients is very toxic in the elderly. The three main therapeutic alternatives offered to the physician in elderly patients are: (1) initial therapeutic abstention followed by palliative chemotherapy habitually using hydroxyurea when control of hyperleukocytosis is required; (2) intensive chemotherapy with anthracyclines and cytosine arabinoside (araC) based regimens, which induces complete remission in 45 to 50 per cent of the cases at the price of an initial toxic death rate of approximately 30 per cent, with 5 to 15 per cent of the patients possibly being cured, and (3) low-dose araC inducing complete remission, generally of shorter duration, in 25 to 30 per cent of the patients with about 10 per cent toxic deaths. In the absence of randomized trial comparing these approaches, there are no objective criteria enabling precise therapeutic indications to be defined. Poor initial general condition and a past history of myelodysplastic syndrome are widely accepted factors of poor prognosis whatever the therapeutic strategy used.