Treatment of Older Patients with Acute Myeloid Leukemia (AML)

The inferior outcome in the older patients with AML when compared with that in younger patients can be explained, in part, by a traditional undertreatment in most of the published series. In correspondence to the benefit of patients under age 60 from highdose AraC there are dose effects in the over 60es in particular for daunorubicin in the induction treatment, and for the quantity in terms of duration of postremission treatment. The use of these effects can partly overcome the mostly unfavorable disease biology in older age AML as expressed by the absence of favorable and the overrepresentation of adverse chromosomal abnormalities as well as the expression of drug resistance. We recommend an adequate dosage of 60 mg/m2 daunorubicin on three days in a combination with standard dose AraC and 6-thioguanine given for induction and consolidation and followed by a prolonged monthly maintenance chemotherapy for an at least one year duration. Further improvements in supportive care may help delivering additional antileukemic cytotoxicity. As a novel approach, non-myeloablative preparative regimens may open allogeneic transplantation for older patients with AML. Given the actual median age in this disease being more than 60 years the management of older age AML remains as the major challenge.