Prognostic factors in elderly patients with acute myeloid leukaemia

Acute myeloid leukaemia (AML) is predominantly a disease of the elderly; the median age of incidence is 64 years, and 60% of all cases are over 60. With improved chemotherapy regimens and maximal supportive care, remission rates of up to 60% may be achieved in selected elderly patients. Whilst intensive chemotherapy is the treatment of choice for fit patients, it may be inappropriate for debilitated patients with poor prognosis disease in whom supportive care or palliative chemotherapy may be more suitable. AML in the elderly exhibits biological differences from AML in younger patients, and elderly patients may be unable to withstand the rigors of the intensive treatment regimens given to younger patients. We review methods to evaluate prognostic factors, the development and application of prognostic models, and available data regarding prognostic factors in elderly patients with AML. We discuss a rationale for the use of prognostic factors in selecting therapy for patients and for tailoring of therapy according to disease and host related variables.