Leger Chantal S, Leitch Heather A, Galbraith Paul F, Li Charles H, Vickars Linda M
Medicine, University of British Columbia, British Columbia, Vancouver, Canada.
Am J Clin Oncol. 2009 Apr;32(2):137-41. doi: 10.1097/COC.0b013e31818a6c93.
Acute leukemia, particularly acute myeloid leukemia, occurs more frequently in the elderly, a growing segment of the North American population. To evaluate our progress in the diagnosis, treatment and outcome of this condition, we reviewed our experience of all patients > or =60 years of age diagnosed with acute leukemia over a 20-year period at Saint Paul's Hospital, a university-based hospital in Vancouver, Canada.
A retrospective chart review was performed of 103 patients > or =60 years of age diagnosed with acute leukemia (acute myeloid leukemia-81; acute lymphoid leukemia-15; acute leukemia not otherwise specified-7).
Median age was 72 (range 60-88) years. Bone marrow aspirate yielded cytogenetic information on 57 patients and 18 (31.6%) had an unfavourable karyotype. Fifty-three (51%) patients received induction chemotherapy (treated) and 50 (49%) were palliated (untreated). Treated patients were younger [median 67 years (range 60-79)] than untreated patients [76 years (61-88)], (P < 0.0001). Of the treated patients, 33 (62%) achieved a complete remission. The median overall survival for the group was 104 (1-2689) days, and for treated versus untreated patients-219 (1-2689) and 39 (2-1229) days, respectively (P = 0.0021). Univariate variables predictive of prolonged survival included induction chemotherapy (P = 0.0027), de novo leukemia (P = 0.0420), and younger age, with a relative increase in death in older subgroups (60-69, 70-79, 80+), (P = 0.0311). Induction chemotherapy was the only predictor of prolonged survival in multivariate analysis (P = 0.0027).
The prognosis of acute leukemia in older patients remains poor, and even though induction chemotherapy seem to prolong survival in patients able to receive treatment, most ultimately die of leukemia.
急性白血病，尤其是急性髓系白血病，在老年人中更为常见，而老年人是北美人口中不断增长的一部分。为了评估我们在这种疾病的诊断、治疗和预后方面取得的进展，我们回顾了在加拿大温哥华一家大学附属医院圣保罗医院20年间所有年龄≥60岁的急性白血病患者的诊疗经验。
对103例年龄≥60岁的急性白血病患者（急性髓系白血病81例；急性淋巴细胞白血病15例；未另行分类的急性白血病7例）进行回顾性病历审查。
中位年龄为72岁（范围60 - 88岁）。57例患者的骨髓穿刺获得了细胞遗传学信息，其中18例（31.6%）具有不良核型。53例（51%）患者接受了诱导化疗（治疗组），50例（49%）接受了姑息治疗（未治疗组）。治疗组患者比未治疗组患者年轻[中位年龄67岁（范围60 - 79岁）vs 76岁（61 - 88岁）]，（P < 0.0001）。在治疗组患者中，33例（62%）达到完全缓解。该组患者的中位总生存期为104天（1 - 2689天），治疗组和未治疗组患者分别为219天（1 - 2689天）和39天（2 - 1229天），（P = 0.0021）。预测生存期延长的单变量因素包括诱导化疗（P = 0.0027）、初发白血病（P = 0.0420）和较年轻的年龄，年龄较大的亚组（60 - 69岁、70 - 79岁、80岁及以上）死亡相对增加，（P = 0.0311）。在多变量分析中，诱导化疗是生存期延长的唯一预测因素（P = 0.0027）。
老年急性白血病患者的预后仍然很差，尽管诱导化疗似乎能延长能够接受治疗患者的生存期，但大多数患者最终仍死于白血病。
