Abstract
The clinical characteristics and therapeutic strategy in acute myeloid leukemia (AML) are influenced by patients' age. We evaluated the impact of age on remission induction therapy for AML. We retrospectively analyzed 3,011 adult AML patients identified from a nationwide database between January 2007 and December 2011. Three hundred twenty-nine (10.9%) acute promyelocytic leukemia (APL) and 2,682 (89.1%) non-APL patients were analyzed. The median age was 51 years and 55% of patients were male. Six hundred twenty-three patients (21%) were at favorable risk, 1522 (51%) were at intermediate risk, and 743 (25%) were at poor risk. As the age increased, the proportion of those at favorable risk and who received induction chemotherapy decreased. After induction therapy, complete response (CR) was achieved in 81.5% (243/298) of APL and 62.4% (1,409/2,258) of non-APL patients; these rates decreased as the age increased, with an obvious decrement in those older than 60 years. The median overall survival of non-APL patients was 18.7 months, while that of APL patients was not reached, with a 75% five-year survival rate. Age impacts both the biology and clinical outcomes of AML patients. Further studies should confirm the role of induction remission chemotherapy by age group.
Highlights
Acute myeloid leukemia (AML), characterized by the clonal expansion of myeloid blasts resulting from somatic mutations in primitive multipotential hematopoietic cells, is the most common acute leukemia in adults [1]
Complete response (CR) was achieved in 81.5% (243/298) of acute promyelocytic leukemia (APL) and 62.4% (1,409/2,258) of non-APL patients; these rates decreased as the age increased, with an obvious decrement in those older than 60 years
Further studies should confirm the role of induction remission chemotherapy by age group
Summary
Acute myeloid leukemia (AML), characterized by the clonal expansion of myeloid blasts resulting from somatic mutations in primitive multipotential hematopoietic cells, is the most common acute leukemia in adults [1]. The initial treatment strategy for AML is established by considering patients’ age and performance status. Those younger than 60 years are generally treated with remission induction chemotherapy based on a backbone of cytarabine plus an anthracycline [6]. The treatment of older adults with AML encounters two major obstacles: therapeutic resistance of the disease and patients’ intolerance to intensive chemotherapy [7].
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