Division of Hematology/BMT Unit, Patras University Hospital, Patras, Greece.
J Oncol. 2010;2010:943823. doi: 10.1155/2010/943823. Epub 2010 Jun 10.
Whereas in younger patients diagnosed with acute myeloid leukemia (AML) treatment is straightforward and the goal is cure, the optimal treatment decision for older adults remains highly controversial. Physicians need to determine whether palliation, "something" beyond palliation, intensive therapy, or an investigational therapy is the most appropriate treatment option. This requires understanding of the biology and risk profile of the AML, clinical judgment in evaluating the functional status of the patient, communication skills in understanding the patient's wishes and social background, and medical expertise in available therapies. The physician has to accurately inform the patient about (a) the unique biological considerations of his leukemia and his prognosis; (b) the risks and benefits of all available treatment options; (c) novel therapeutic approaches and how the patient can get access to these treatments. Last but not least, he has to recommend a treatment. This paper tries to discuss each of these issues.
虽然在诊断为急性髓细胞白血病 (AML) 的年轻患者中，治疗方法简单明确，目标是治愈，但对于老年人来说，最佳治疗决策仍存在很大争议。医生需要确定姑息治疗、姑息治疗以外的方法、强化治疗还是试验性治疗是最合适的治疗选择。这需要了解 AML 的生物学和风险特征，在评估患者功能状态时运用临床判断，理解患者的意愿和社会背景所需的沟通技巧，以及在可用疗法方面的医学专业知识。医生必须准确地告知患者：(a) 其白血病的独特生物学考虑因素和预后；(b) 所有可用治疗方案的风险和获益；(c) 新的治疗方法以及患者如何获得这些治疗。最后但同样重要的是，他必须推荐一种治疗方案。本文试图讨论其中的每一个问题。
