Tandon N, Banavali S, Menon H, Gujral S, Kadam P A, Bakshi A
Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India.
Indian J Cancer. 2013 Apr-Jun;50(2):154-8. doi: 10.4103/0019-509X.117033.
Acute myeloid leukemia (AML) in older adults differs biologically and clinically from that in younger patients and is characterized by adverse chromosomal abnormalities, stronger intrinsic resistance, and lower tolerance to chemotherapy. In patients over age 60 with AML, cure rates are under 10% despite intensive chemotherapy, and most of them die within a year of diagnosis. Over the last decade, metronomic chemotherapy has emerged as a potential strategy to control advanced/refractory cancer. Here, we report a case of a 68-year-old gentleman having AML with high-risk cytogenetic features, who achieved complete remission on our oral metronomic PrET (PrET: Prednisolone, etoposide, thioguanine) protocol on an outpatient basis. He was later treated with standard high-dose (HD) cytosine arabinoside (Ara-C) consolidation followed by maintenance with etoposide, thioguanine, and sodium valproate. Presently, the patient is nearly 35 months since diagnosis and 21 months off treatment. This case report and review highlights that the combination of oral low-intensity metronomic therapy, followed by standard HD consolidation therapy and metronomic maintenance therapy may be well tolerated by elderly patients especially with less proliferative, high (cytogenetic)-risk AML who are otherwise deemed to be unfit for intensive intravenous induction chemotherapy regimens. References for this review were identified through searches of Pubmed for recent publications on the subject as well as searches of the files of the authors themselves. The final list was generated on the basis of originality and relevance to this review.
老年急性髓系白血病（AML）在生物学和临床上与年轻患者不同，其特征为存在不良染色体异常、较强的内在耐药性以及对化疗的耐受性较低。在60岁以上的AML患者中，尽管进行了强化化疗，治愈率仍低于10%，且大多数患者在诊断后一年内死亡。在过去十年中，节拍化疗已成为控制晚期/难治性癌症的一种潜在策略。在此，我们报告一例68岁男性AML患者，其具有高危细胞遗传学特征，在我们的口服节拍PrET（PrET：泼尼松龙、依托泊苷、硫鸟嘌呤）方案门诊治疗下实现了完全缓解。他随后接受了标准高剂量（HD）阿糖胞苷（Ara-C）巩固治疗，之后用依托泊苷、硫鸟嘌呤和丙戊酸钠进行维持治疗。目前，该患者自诊断以来已近35个月，停药21个月。本病例报告及综述强调，口服低强度节拍疗法，随后进行标准HD巩固疗法和节拍维持疗法的联合应用，老年患者尤其是增殖性较低、（细胞遗传学）高危AML患者可能耐受性良好，否则这些患者被认为不适合强化静脉诱导化疗方案。本综述的参考文献通过在Pubmed上搜索关于该主题的近期出版物以及搜索作者本人的文件来确定。最终列表是根据与本综述的原创性和相关性生成的。
