Targeting age-related changes in the biology of acute myeloid leukemia: is the patient seeing the progress?

The prognosis of acute myeloid leukemia (AML) in the elderly is poor with overall less than 5% of the patients expected to be alive after 5 years. In many studies, age was an independent poor prognostic factor. In the elderly, the frequency of secondary forms of AML, of unfavorable cytogenetics, expression of multidrug resistance genes in part explains the poor outcome. However, based on genetic and molecular studies, there is no evidence for specific biological features of the disease in the elderly. Host-related factors including comorbidity and reduced functional reserves also account for the severity of the disease. Finally, population-based studies show that approximately 30% of patients older than 65 years are offered intensive chemotherapy. This chapter summarizes the recent advances in the biology of AML, in particular the impact of new molecular markers. An overview of the studies that have evaluated comorbidities and results of geriatric assessments in these patients are also presented.