Dana-Farber Cancer Institute, Boston, MA 02215, USA.
Curr Treat Options Oncol. 2011 Dec;12(4):341-53. doi: 10.1007/s11864-011-0162-4.
Older patients with acute myelogenous leukemia (AML) fare much less well than younger patients with the same disease due to a combination of comorbidities and intrinsic disease resistance. Likely due to aging of the US population, the median age of AML patients at diagnosis has increased from 68 to 72 years. AML is a heterogeneous disease, particularly in older patients, making therapeutic decisions challenging. Older patients who are 'fit' for intensive chemotherapy and would have a reasonable chance to benefit based on host and disease characteristics should receive standard induction chemotherapy with 7 days of continuous infusion of cytarabine and at least 60 mg/m(2) daunorubicin daily for 3 days. Therapeutic options for patients who are not candidates for or are not likely to respond to intensive therapy include clofarabine, low intensity chemotherapy such as low dose cytarabine, hypomethylating agents, or investigational agents. For older AML patients in complete remission, post-remission or consolidation chemotherapy with repeat induction or modified high dose cytarabine may offer a small chance for long term disease-free survival. Selected older patients who achieve remission by any means should be considered for reduced-intensity stem cell transplantation which may offer improved chances of cure and survival compared with standard post-remission chemotherapy.
由于合并症和内在疾病耐药性的综合因素，老年急性髓系白血病 (AML) 患者的预后远不如同病年轻患者。由于美国人口老龄化，AML 患者的中位诊断年龄已从 68 岁增加到 72 岁。AML 是一种异质性疾病，尤其是在老年患者中，这使得治疗决策具有挑战性。对于适合强化化疗且根据宿主和疾病特征有合理获益机会的“健康”老年患者，应接受标准诱导化疗，用 7 天连续输注阿糖胞苷和至少 60mg/m(2)每天 3 天的柔红霉素。不适合或不太可能对强化治疗有反应的患者的治疗选择包括氯法拉滨、低强度化疗（如低剂量阿糖胞苷）、低甲基化剂或研究药物。对于完全缓解、缓解后或巩固化疗的老年 AML 患者，重复诱导或改良高剂量阿糖胞苷可能有机会获得长期无病生存。通过任何方式达到缓解的选定老年患者应考虑接受强度降低的干细胞移植，与标准缓解后化疗相比，可能有更好的治愈和生存机会。
