Acute Myeloid Leukemia Clinical Trial
Official title:
Treatment With Low-Dose Cytarabine in Elderly Patients (Age 70 Years or Older) With Acute Myeloid Leukemia: A Single Institution Experience.
The treatment of very elderly patients (≥70 years) with acute myeloid leukemia remains
controversial. Although the outcome in younger adults has improved because of cytarabine- and
anthracycline-based chemotherapy with advanced supportive care and introduction of
hematopoietic stem cell transplantation, the benefit associated with standard intensive
chemotherapy in older patients remain debatable. Life expectancy in elderly patients is a
function of age, disability and comorbidity, performance score, along with leukemia
characteristics such as genetic alterations or white blood cell count at diagnosis 'Older'
patients are generally considered those aged 60 years or older.
Intensive chemotherapy delivered to the very elderly with AML (patients _70 years of age),
may not be beneficial to most and could be harmful to some. However, these patients are often
referred to as 'unfit' or ineligible for intensive remission induction therapy. In daily
practice, the final decision to treat intensively or not is made by the treating hematologist
on a case by case basis according to patient's age, cytogenetics, performance score,
concomitant diseases and type of AML (de novo or secondary).
In older patients considered 'unfit' for intensive treatment, LD-AraC has been demonstrated
to be more beneficial than best supportive care and hydroxyurea. The recent availability of
new drugs that may have an improved side effect profile and in some cases bioavailability may
offer future improvement for this patient population. The efficacy of hypomethylating agents
has been studied in older AML patients with conflicting results. Recent publications refined
prognostic information, which not only optimize existing treatments but also could lead to
the development of additional targeted therapeutic approaches.
In this study, the investigators focus on patients with AML (_20% blasts) aged 70 or older
seen in our institution over a 14-year period. The objectives of the analysis are to describe
the demographic, clinical and biological characteristics of this population and to evaluate
how these characteristics and the treatment chosen affect
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