Estey Elihu H
Department of Leukemia, M.D. Anderson Cancer Center, Houston, TX 77030, USA.
Semin Hematol. 2006 Apr;43(2):89-95. doi: 10.1053/j.seminhematol.2006.01.002.
Most patients aged>or=55 to 60 years who are treated for newly diagnosed acute myeloid leukemia (AML) receive a combination of an anthracycline plus cytarabine (ara-C). A principal thesis of this chapter is that such therapy is unsatisfactory for the great majority of such patients. In particular, the >or=15% risk of death in the month following the start of treatment is difficult to justify given median survivals of less than 1 year in the patients who do not die early. Thus, investigational therapy should be recommended for most, if not all, older patients. In patients for whom such therapy is not feasible, low-dose ara-C is a reasonable alternative except for patients with de novo disease and a normal karyotype, who might benefit more from an anthracycline+ara-C combination, and patients with either a poor performance status, abnormal organ function, or age>or=80, for whom supportive/palliative care only is recommended. Distinctions are made between investigational therapies likely associated with lower and higher risks of treatment-related mortality (TRM). The former are preferable initial treatment in patients aged 70 and above, or with abnormal cytogenetics. Three topics are discussed that are likely to be relevant to future clinical research in older patients: the possibility of delaying therapy to gain information about prognosis with initial induction therapy, the clinical value of responses less than conventional complete remission (CR), and the possibility of looking for larger differences between treatments in randomized clinical trials.
大多数年龄≥55至60岁、接受新诊断急性髓系白血病（AML）治疗的患者会接受蒽环类药物加阿糖胞苷（ara-C）的联合治疗。本章的一个主要观点是，这种治疗方法对绝大多数此类患者并不令人满意。特别是，鉴于未早期死亡患者的中位生存期不到1年，治疗开始后1个月内≥15%的死亡风险难以说得过去。因此，对于大多数（如果不是全部）老年患者，应推荐进行试验性治疗。对于无法进行这种治疗的患者，低剂量阿糖胞苷是一种合理的替代方案，但初发疾病且核型正常的患者可能从蒽环类药物+阿糖胞苷联合治疗中获益更多，而对于那些体能状态差、器官功能异常或年龄≥80岁的患者，仅推荐支持性/姑息性治疗。区分了可能与较低和较高治疗相关死亡率（TRM）风险相关的试验性治疗方法。前者更适合70岁及以上或细胞遗传学异常的患者作为初始治疗。讨论了三个可能与老年患者未来临床研究相关的主题：延迟治疗以获取初始诱导治疗预后信息的可能性、低于传统完全缓解（CR）的缓解的临床价值，以及在随机临床试验中寻找不同治疗方法之间更大差异的可能性。
