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[Treatment of acute myelogenous leukemia in patients more than 80 years old]
H Takeyama1, Y Yamamoto, Y Miyata
1Dept. of Internal Medicine, Nagoya Ekisaikai Hospital.
Abstract:
We studied fifteen patients older than 80 years of age with acute myelogenous leukemia (AML) treated between 1984 and 1996. Among 15 cases of AML including 7 de novo cases and 8 from myelodysplastic syndrome (MDS) or hypoplastic leukemia, 14 patients had complications, including cardiovascular disease, diabetes mellitus or other malignancies. Although patients with de novo AML showed high peripheral WBC counts and higher cellularity of bone marrow than those from MDS or hypoplastic leukemia, it was difficult in some cases to distinguish these types of AML from hematological findings. Of the 6 AML cases, three had entered complete remission (CR) by a standard dose of combination chemotherapy (BHAC-DMP). One CR patient has had CR for more than 9 years now with good QOL. Among the 3 patients treated by low-dose Ara-C, one attained CR but only for a short period. Four other patients received BRM, such as G-CSF or Ubenimex, and 2 patients died without chemotherapy. Since AML at more than 80 years of age is a highly heterogenous disease, it would be reasonable to give antileukemic agents according to the individual patient's condition.
Insights
Elderly patients over 80 with acute myelogenous leukemia (AML) often have comorbidities. Treatment should be individualized due to the heterogeneous nature of AML in this age group.
Area of Science:
- Hematology
- Geriatric Medicine
- Oncology
Background:
- Acute myelogenous leukemia (AML) in patients over 80 presents unique challenges.
- Comorbidities are highly prevalent in this elderly population, impacting treatment decisions.
- Distinguishing de novo AML from secondary AML (from myelodysplastic syndrome or hypoplastic leukemia) can be difficult based solely on hematological findings.
Purpose of the Study:
- To analyze the characteristics and outcomes of acute myelogenous leukemia (AML) in patients aged 80 years and older.
- To evaluate the efficacy of different treatment approaches in this specific patient cohort.
- To emphasize the need for personalized treatment strategies in elderly AML patients.
Main Methods:
- Retrospective analysis of 15 patients aged over 80 with AML treated between 1984 and 1996.
- Categorization of AML cases into de novo and secondary (from myelodysplastic syndrome or hypoplastic leukemia).
- Review of patient complications, treatment regimens (standard chemotherapy, low-dose Ara-C, biological response modifiers), and remission status.
Main Results:
- 14 out of 15 patients had significant comorbidities (cardiovascular disease, diabetes, other malignancies).
- Standard dose combination chemotherapy (BHAC-DMP) achieved complete remission (CR) in 3 out of 6 patients, with one long-term survivor.
- Low-dose Ara-C resulted in a short-term CR in one patient; biological response modifiers (BRM) were used in four patients.
- Two patients died without receiving chemotherapy.
Conclusions:
- Acute myelogenous leukemia (AML) in patients over 80 is a highly heterogeneous disease.
- Treatment decisions for elderly AML patients must consider individual patient conditions and comorbidities.
- Personalized therapeutic approaches are crucial for optimizing outcomes in this vulnerable population.