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ASCO Educational Book; 2008
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Acute Leukemia in Older Adults: Are We Treating Too Much or Too Little?

Maria R. Baer, MD, Heidi D. Klepin, MD, and Andrew S. Artz, MD, MS

From the Greenebaum Cancer Center, University of Maryland School of Medicine, Baltimore, Maryland; Comprehensive Cancer Center of Wake Forest University, Section on Hematology and Oncology, Wake Forest University School of Medicine, Winston-Salem, North Carolina; and the Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, Illinois

Authors’ disclosures of potential conflicts of interest are found at the end of this article.

Address reprint requests to Maria R. Baer, MD, Greenebaum Cancer Center, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD 21201; e-mail: mbaer{at}umm.edu

Overview: Acute leukemia incidence in adults increases with age. Older patients with acute leukemia have worse treatment outcomes than younger patients, with increased treatment-related morbidity and mortality, lower remission rates, and shorter disease-free and overall survival. Outcome disparity reflects age-related biology not only of patients, but also of leukemia cells, including higher frequencies of secondary disease, unfavorable cytogenetic abnormalities and multidrug resistance phenotypes in acute myeloid leukemia, and Philadelphia chromosome-positive acute lymphoblastic leukemia. New agents — including hypomethylating agents, signal transduction inhibitors, and bcr-abl inhibitors — are being evaluated in older patients with acute leukemia. In addition to tumor biology, patient-specific factors — including impaired physical function and comorbidity — independently predict increased treatment toxicity and short survival. Improving patient assessment strategies is critical to identifying patients who are likely to benefit from induction and postremission therapies, including hematopoietic cell transplantation. Optimizing functional status during treatment using novel supportive care strategies may help maximize treatment benefits and availability of subsequent treatment options, including hematopoietic cell transplantation. Advances in transplantation, including use of reduced-intensity conditioning regimens, are increasing availability and efficacy of hematopoietic cell transplantation for older adults.