Juliusson Gunnar, Antunovic Petar, Derolf Asa, Lehmann Sören, Möllgård Lars, Stockelberg Dick, Tidefelt Ulf, Wahlin Anders, Höglund Martin
Department of Hematology and Regional Tumor Registry, Lund University Hospital, Lund, Sweden.
Blood. 2009 Apr 30;113(18):4179-87. doi: 10.1182/blood-2008-07-172007. Epub 2008 Nov 13.
Acute myeloid leukemia (AML) is most common in the elderly, and most elderly are thought to be unfit for intensive treatment because of the risk of fatal toxicity. The Swedish Acute Leukemia Registry covers 98% of all patients with AML (nonacute promyelocytic leukemia) diagnosed in 1997 to 2005 (n = 2767), with a median follow-up of 5 years, and reports eligibility for intensive therapy, performance status (PS), complete remission rates, and survival. Outcomes were strongly age and PS dependent. Early death rates were always lower with intensive therapy than with palliation only. Long-term survivors were found among elderly given intensive treatment despite poor initial PS. Total survival of elderly AML patients was better in the geographic regions where most of them were given standard intensive therapy. This analysis provides unique real world data from a large, complete, and unselected AML population, both treated and untreated, and gives background to treatment decisions for the elderly. Standard intensive treatment improves early death rates and long-term survival compared with palliation. Most AML patients up to 80 years of age should be considered fit for intensive therapy, and new therapies must be compared with standard induction.
急性髓系白血病（AML）在老年人中最为常见，大多数老年人因存在致命毒性风险而被认为不适合进行强化治疗。瑞典急性白血病登记处涵盖了1997年至2005年诊断出的所有AML患者（非急性早幼粒细胞白血病）的98%（n = 2767），中位随访时间为5年，并报告了强化治疗的 eligibility、体能状态（PS）、完全缓解率和生存率。结果强烈依赖于年龄和PS。强化治疗的早期死亡率始终低于仅采用姑息治疗的情况。尽管初始PS较差，但在接受强化治疗的老年人中发现了长期存活者。在大多数老年AML患者接受标准强化治疗的地理区域，其总生存率更高。该分析提供了来自一个大型、完整且未经过筛选的AML人群（包括接受治疗和未接受治疗的患者）的独特真实世界数据，并为老年人的治疗决策提供了背景信息。与姑息治疗相比，标准强化治疗可提高早期死亡率和长期生存率。大多数80岁以下的AML患者应被认为适合进行强化治疗，并且必须将新疗法与标准诱导疗法进行比较。
