General approach to, and perspectives on clinical research in, older patients with newly diagnosed acute myeloid leukemia

Seminars in Hematology
Elihu Estey

Abstract

Most patients aged>or=55 to 60 years who are treated for newly diagnosed acute myeloid leukemia (AML) receive a combination of an anthracycline plus cytarabine (ara-C). A principal thesis of this chapter is that such therapy is unsatisfactory for the great majority of such patients. In particular, the >or=15% risk of death in the month following the start of treatment is difficult to justify given median survivals of less than 1 year in the patients who do not die early. Thus, investigational therapy should be recommended for most, if not all, older patients. In patients for whom such therapy is not feasible, low-dose ara-C is a reasonable alternative except for patients with de novo disease and a normal karyotype, who might benefit more from an anthracycline+ara-C combination, and patients with either a poor performance status, abnormal organ function, or age>or=80, for whom supportive/palliative care only is recommended. Distinctions are made between investigational therapies likely associated with lower and higher risks of treatment-related mortality (TRM). The former are preferable initial treatment in patients aged 70 and above, or with abnormal cytogenetics. Three topics are discussed that are likely to be relevant to fut...Continue Reading

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Citations

Apr 1, 2008·Current Hematologic Malignancy Reports·David WaldWilliam Tse
Jun 6, 2009·Journal of Hematology & Oncology·Tara K GregoryWilliam Tse
Nov 28, 2006·Lancet·Elihu Estey, Hartmut Döhner
Nov 13, 2007·Critical Reviews in Oncology/hematology·Felicetto FerraraFranco Leoni
Oct 7, 2014·Leukemia·J J Ignatz-HooverD N Wald
May 5, 2010·Oncology Nursing Forum·Barbara B Rogers
May 10, 2007·Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology·Stuart M LichtmanUNKNOWN International Society of Geriatric Oncology Chemotherapy Taskforce
May 10, 2007·Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology·Elihu Estey
May 10, 2018·Leukemia & Lymphoma·Maro OhanianJorge E Cortes
Nov 21, 2017·Supportive Care in Cancer : Official Journal of the Multinational Association of Supportive Care in Cancer·Neha KayasthaThomas W LeBlanc
Jan 10, 2012·Leukemia·K GuptaD N Wald
Mar 7, 2007·Expert Review of Anticancer Therapy·Gail J Roboz
Feb 5, 2013·Expert Review of Hematology·Niamh KeaneFrancis J Giles
Jan 20, 2012·Deutsches Ärzteblatt International·Utz KrugCarsten Müller-Tidow

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