Disciplina de Hematologia e Hemoterapia, UNIFESP - Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo/SP, Brazil.
Clinics (Sao Paulo). 2011;66(8):1335-40. doi: 10.1590/s1807-59322011000800005.
To evaluate the outcomes of acute myeloid leukemia patients who were older than 60 years of age at the time of diagnosis following the implementation of a treatment algorithm based on age, performance status, and cytogenetic results.
We retrospectively compared the results of 31 elderly acute myeloid leukemia patients (median age of 74 years) who were treated according to the new algorithm.
Fifteen patients with a good performance status and no unfavorable karyotypes were treated with either intensive cytotoxic chemotherapy (<70 years, nine cases) or adapted etoposide, 6-thioguanine and idarubicine (>70 years, six cases); 16 cases with a poor performance status or unfavorable cytogenetics received supportive care only. Six patients achieved a complete remission and two achieved a partial remission after chemotherapy. There were three toxic deaths during induction, two in the adapted etoposide, 6-thioguanine and idarubicine group and one in the intensive cytotoxic chemotherapy group. The overall median survival time was 2.96 months, 1.3 months in the supportive care group, and 4.6 months in the treatment group.
Our results illustrate the importance of treatment guidelines adapted to local resources in an attempt to improve the survival of elderly acute myeloid leukemia patients in developing countries.
评估在根据年龄、体能状态和细胞遗传学结果制定的治疗方案实施后，诊断时年龄超过 60 岁的急性髓系白血病患者的结局。
我们回顾性比较了 31 例按照新方案治疗的老年急性髓系白血病患者（中位年龄 74 岁）的结果。
15 例体能状态良好且无不良核型的患者接受了强化细胞毒化疗（<70 岁，9 例）或适应性依托泊苷、6-巯基嘌呤和伊达比星（>70 岁，6 例）治疗；16 例体能状态差或细胞遗传学不良的患者仅接受支持性治疗。6 例患者在化疗后获得完全缓解，2 例获得部分缓解。诱导期间有 3 例因毒性死亡，2 例在适应性依托泊苷、6-巯基嘌呤和伊达比星组，1 例在强化细胞毒化疗组。总体中位生存时间为 2.96 个月，支持治疗组为 1.3 个月，治疗组为 4.6 个月。
我们的结果表明，在发展中国家，制定适应当地资源的治疗指南对于改善老年急性髓系白血病患者的生存至关重要。
