De behandeling van de oudere patiënt met acute myeloïde leukemie

Stand van zaken
B. Löwenberg

The treatment of the elderly patient with acute myelogenous leukaemia

– More than 50 of patients with acute myelogenous leukaemia are 60 years or older. Unlike the results of treatment of younger adults, the outcome in patients of higher age has been disappointing because intensive chemotherapy is tolerated less well, complications due to cardiac and pulmonary comorbidity occur sooner, toxicity due to reduced hepatic and renal function occurs earlier and older patients often present with leukaemia that is intrinsically of higher risk (e.g. unfavourable cytogenetics).

– Remission-induction therapy with an anthracycline derivative and cytarabine results in complete remission rates of approximately 50 in older patients; 15-20 of these remain free of leukaemia beyond 2-3 years and have a good quality of life.

– The clinical use of hematopoietic growth factors as adjuncts to chemotherapy to reduce complications and improve survival has not (yet) fulfilled his promise.

– By selecting older patients without major comorbidity for therapy and assessing the response to a first cycle of chemotherapy one may identify patients with the best response to treatment and avoid continued therapy in patients with poor prognosis. In this way the choice of treatment of the individual older patient can be optimized.