Acute myeloblastic leukaemia in the elderly: biology, prognostic factors and treatment

Elderly patients (> 60 years) with acute myeloblastic leukaemia (AML) have significantly inferior remission rates (around 50%) and median survival times (5-6 months) despite intensive therapy, compared with younger AML patients. This observation emanating from several large clinical studies has made treatment of elderly AML patients a highly controversial issue, with clinicians largely polarizing to one extreme viewpoint or the other. This article summarises the current understanding of the biology and the resultant justification for the assertion that AML in elderly patients is a distinct clinical entity; provides a useful list of prognostic factors to enable a rational therapeutic decision in individual patients; reviews the encouraging results with low-dose combination chemotherapy in small, non-randomized studies from four different centres; and draws attention to the possible significance of drug scheduling and pharmacokinetics in the treatment of elderly patients.