Management of acutemyeloid leukemia in older adults

Introduction It is estimated that acute myeloid leukemia (AML) accounts for 70 percent of newly diagnosed acute leukemias. In the United States, approximately 13,000 individuals were diagnosed with AML in 2008, and nearly 9,000 died of the disease. Notably, 35 percent of patients with newly diagnosed AML are 75 years of age or older, and the median age at diagnosis is 67 years. The incidence of AML will likely increase over time, as the number of individuals over 65 years of age in the United States – estimated to be 37.3 million in 2006 – is expected to double by year 2030 and represent 20 percent of the population. Elderly patients, defined in the AML literature as those aged 60 years or older, historically have lower complete remission (CR) and relapse-free survival (RFS) rates when compared to their younger counterparts. In elderly patients with AML, CR rates vary between 30 and 50 percent, with the lowest value reported for patients aged 70–75 years (CR rate about 38%) and for those over 75 years (CR rate about 22%). In contrast, in patients aged up to 50–55 years, CR rates vary between 70 and 80 percent. More important, most studies have shown that median RFS in AML patients older than 60 years is significantly lower, that is, less than 12 months, as opposed to younger adults (i.e., up to 50 years of age), who tend to have longer RFS of almost 24 months.

Duke Scholars

Author Joseph Odell Moore Medicine, Hematological Malignancies