Treatment of acute myeloid leukemia in the elderly

Estey, Elihu H.

doi:10.3324/haematol.2011.044776

Cited by 3 publications

(2 citation statements)

References 22 publications

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“…However existing clinical data regarding cytogenetics are mainly observational and their clinical utilization is mostly confined to the assignment of post‐remission therapy. Cytogenetics have no direct impact on the initial induction regimen chosen, except perhaps in older adults with very unfavourable cytogenetics where the dismal outlook could influence a decision to elect for alternative therapies (Estey, ). Decisions regarding post‐remission therapy may be made following completion of induction or, as in the UK, after the first cycle of induction, especially in those patients who have an incomplete response.…”

Section: Genetic Prognostic Markers Identified In Amlmentioning

confidence: 99%

Genetic profiling in acute myeloid leukaemia ─ where are we and what is its role in patient management

Ofran

Rowe

2012

Br J Haematol

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SummaryGenetic profiling in acute myeloid leukaemia (AML) is a moving target. Only 4 years ago, AML was re-classified, based on karyotypic abnormalities. However, numerous important new mutations and other genetic abnormalities that were not considered in this classification have been identified. Current cytogenetic-based classification is limited by the substantial number of intermediate-risk patients in whom the preferred therapy is debatable. In addition, the majority of AML patients co-express multiple mutations and cannot be easily categorized into predefined homogenous groups. The tremendous progress in mass sequencing allows parallel identification of multiple genetic aberrations in large cohorts. Thus, a new concept of genetic profiling has arisen. Genes and proteins biologically interact with each other; therefore, it should not be surprising that mutations in different genes interact. Prognosis is determined by the composition of mutations and aberrations in leukaemic stem cells. As a consequence, clinical decisions no longer rely on scant genetic data and require comprehensive genetic evaluation. Some non-genetic parameters are also important and should be incorporated into the clinical decision algorithm. Genetic interaction-based profiles are challenging and recent studies demonstrate an improvement in prognostic predictions with this model. Thus, genetic profiling is likely to have a major therapeutic impact, at least for intermediate-risk cytogenetics.

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Section: Genetic Prognostic Markers Identified In Amlmentioning

confidence: 99%

Genetic profiling in acute myeloid leukaemia ─ where are we and what is its role in patient management

Ofran

Rowe

2012

Br J Haematol

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“…The management of older individuals with MN takes into account characteristics related to the patient and to the disease. 2–6 The chronological age, the performance status (PS) and the comorbidity score are patient-related variables that are considered during treatment decision making of elderly individuals. 7–9 …”

Section: Introductionmentioning

confidence: 99%

A model for the functional assessment of elderly with myeloid neoplasms

Carbonell

Salhab

Giampaoli

et al. 2015

Revista Brasileira de Hematologia e Hemoterapia

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ObjectiveMyeloid neoplasms are heterogeneous diseases that are more incident in the elderly. The goals of this study were to aggregate a geriatric approach to the patient assessment, to show the impact of gender, age, hemoglobin concentration and comorbidities on the functionality of elderly with myeloid neoplasms and to better understand how the instruments of functional assessment work according to the aggressiveness of the disease.MethodsElderly patients (≥60 years old) with myeloid neoplasms were assessed using the Karnofsky scale, Eastern Cooperative Oncologic Group scale, and basic and instrumental activities of daily living scales. The hematopoietic cell transplantation-comorbidity index assessed the comorbidities. A mixed logistical regression model was fitted to estimate the impact of gender, age, hemoglobin concentration and the hematopoietic cell transplantation-comorbidity index on patients’ functionality.ResultsEighty-two patients with a mean age of 72.8 years (range: 60–92 years) were evaluated. Eighty percent had good Karnofsky and Eastern Cooperative Oncologic Group scales and 39% were independent according to the daily living activity scales. All of the patients with poor Karnofsky and Eastern Cooperative Oncologic Group scales were classified as dependent by the daily living activity scales. The mixed logistic regression models showed that age, gender, hemoglobin concentration and the comorbidity index impacted on the daily living activity scales. Karnofsky and Eastern Cooperative Oncologic Group scales were affected by hemoglobin and the comorbidity index. The model hypothesized the hemoglobin concentration at which there was a higher risk of poor Karnofsky and Eastern Cooperative Oncologic Group scales. This hemoglobin concentration depended on comorbidities and on the aggressiveness of the myeloid neoplasm.ConclusionThe geriatric approach improved the sensitivity and specificity of the patients’ assessment. Hemoglobin concentration associated to the risk of poor Karnofsky and Eastern Cooperative Oncologic Group scales depended on the comorbidity score and on the disease aggressiveness. The Karnofsky and Eastern Cooperative Oncologic Group scales had higher sensitivity in patients with more aggressive diseases.

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Intensive chemotherapy for elderly patients with acute myelogeneous leukemia: a propensity score analysis by the Japan Hematology and Oncology Clinical Study Group (J-HOCS)

et al. 2012

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The prognosis of acute myelogenous leukemia (AML) in the elderly patients is extremely poor. Although several previous studies have suggested that intensive chemotherapy is associated with a better prognosis, there may have been a selection bias. Therefore, we retrospectively evaluated the impact of intensive chemotherapy for AML in the elderly by stratifying patients according to a propensity score. Eighty-one AML patients aged 70 years or more were included in this study. Patients with acute promyelocytic leukemia were not included. A propensity score for the use of intensive chemotherapy was calculated from four factors at diagnosis. Forty-five patients received intensive chemotherapy, whereas 36 received low-dose or no chemotherapy. We stratified the patients into quartiles based on the propensity score. The numbers of patients in the first, second, third, and forth quartiles who received intensive chemotherapy were 5 of 21, 10 of 20, 12 of 20, and 18 of 20, respectively. A stratified log-rank test showed significantly better overall survival in the intensive chemotherapy group (P = 0.0088). Especially, in the combined second and third quartiles, which showed an equal tendency for intensive and non-intensive strategies; overall survival at 3 years was 37.5 % for the intensive chemotherapy group and 13.0 % for the non-intensive chemotherapy group (P = 0.0022). A conventional multivariate analysis confirmed that intensive chemotherapy was beneficial (hazard ratio 0.50, 95 % confidence interval 0.27-0.93, P = 0.028). In conclusion, intensive chemotherapy may prolong overall survival in elderly AML patients who are considered to be able to tolerate such treatment based on factors at diagnosis.

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Treatment of acute myeloid leukemia in the elderly

Cited by 3 publications

References 22 publications

Genetic profiling in acute myeloid leukaemia ─ where are we and what is its role in patient management

Genetic profiling in acute myeloid leukaemia ─ where are we and what is its role in patient management

A model for the functional assessment of elderly with myeloid neoplasms

Intensive chemotherapy for elderly patients with acute myelogeneous leukemia: a propensity score analysis by the Japan Hematology and Oncology Clinical Study Group (J-HOCS)

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