Medizinische Klinik A, Universitätsklinikum Münster, Münster, Germany.
Dtsch Arztebl Int. 2011 Dec;108(51-52):863-70. doi: 10.3238/arztebl.2011.0863. Epub 2011 Dec 26.
In patients over age 60 with acute myeloid leukemia (AML), cure rates are under 10% despite intensive chemotherapy. These patients often have comorbidities, and their treatment must be chosen with care. For those who are not candidates for intensive chemotherapy, one of the available options for palliative treatment should be chosen on the basis of an individual risk-benefit assessment.
Selective literature review.
An evaluation of the patient's general condition and comorbidities, a geriatric assessment, and specially designed risk scores are useful aids to the choice of an appropriate treatment. Some elderly patients with AML can benefit from intensive chemotherapy despite their age; for highly selected elderly patients, allogeneic stem-cell transplantation is an increasingly feasible option. Hypomethylating agents or low-dose cytarabine can be suitable for some patients. Further options include experimental treatment as part of a clinical trial, and supportive care alone. In the special case of acute promyelocytic leukemia, more than half of all patients can be cured with combination chemotherapy including all-trans retinoic acid.
The prognosis of elderly AML patients remains poor despite recent therapeutic advances. The appropriate treatment for each patient can be chosen on the basis of a risk-benefit assessment. Clinical trials evaluating new treatments are urgently needed.
尽管接受强化化疗，年龄在 60 岁以上的急性髓系白血病（AML）患者的治愈率仍低于 10%。这些患者通常合并有多种疾病，因此在选择治疗方案时必须谨慎。对于不适合强化化疗的患者，应根据个体风险效益评估选择姑息治疗的可用方案之一。
选择性文献回顾。
评估患者的一般状况和合并症、老年评估以及专门设计的风险评分有助于选择适当的治疗方法。尽管年龄较大，但一些 AML 老年患者仍可从强化化疗中获益；对于高度选择的老年患者，异体造血干细胞移植是一种越来越可行的选择。低甲基化剂或低剂量阿糖胞苷可能适合某些患者。其他选择包括作为临床试验一部分的实验治疗以及单独的支持性护理。在急性早幼粒细胞白血病的特殊情况下，一半以上的患者可以通过包括全反式维甲酸在内的联合化疗治愈。
尽管最近有治疗进展，但老年 AML 患者的预后仍然较差。可以根据风险效益评估为每位患者选择适当的治疗方法。急需评估新疗法的临床试验。
