From the Leukemia Program, Weill Medical College of Cornell University, New York, NY
Author's disclosure of potential conflicts of interest are found at the end of this article.
Address reprint requests to Gail J. Roboz, MD, Associate Professor of Medicine and Director, Leukemia Program, Weill Medical College of Cornell University, 520 East 70th St, Starr 340A, New York, NY 10021; e-mail: gar2001{at}med.cornell.edu
Overview: Clinical trials of novel and conventional agents have failed to improve survival in older patients with acute myeloid leukemia (AML) for 30 years, and the prognosis remains dismal. Although remission can be attained in 45% to 55% of a selected minority of patients with AML who are older than age 60, median survival is still only 8 to 12 months, and outcomes are much worse in patients older than age 70 with unfavorable cytogenetics and/or poor performance status. Deciding which older patients with AML would benefit from intensive chemotherapy is challenging, and new risk assessment instruments are needed. Many new drugs are under development, including signal transduction inhibitors, farnesyltransferase inhibitors, hypomethylating agents, antibodies, and novel chemotherapeutics. The role of reduced-intensity hematopoietic stem cell transplantation, which is clearly feasible in older patients, is under investigation. Older patients with AML should be encouraged to participate in a clinical trial whenever possible, and trials must include measures of quality of life.
