Walter R B, Estey E H
1] Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA [2] Division of Hematology, Department of Medicine, University of Washington, Seattle, WA, USA [3] Department of Epidemiology, University of Washington, Seattle, WA, USA.
1] Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA [2] Division of Hematology, Department of Medicine, University of Washington, Seattle, WA, USA.
Leukemia. 2015 Apr;29(4):770-5. doi: 10.1038/leu.2014.216. Epub 2014 Jul 9.
Acute myeloid leukemia (AML) is primarily a disease of older adults, for whom optimal treatment strategies remain controversial. Because of the concern for therapeutic resistance and, in particular, excessive toxicity or even treatment-related mortality, many older or medically unfit patients do not receive AML-directed therapy. Yet, evidence suggests that outcomes are improved if essentially all of these patients are offered AML therapy, ideally at a specialized cancer center. Medical fitness for tolerating intensive chemotherapy can be estimated relatively accurately with multiparameter assessment tools; this information should serve as basis for the assignment to intensive or non-intensive therapy. Until our accuracy in predicting the success of individual therapies improves, all patients should be considered for participation in a randomized controlled trial. Comparisons between individual trials will be facilitated once standardized, improved response criteria are developed, and standard treatment approaches have been defined against which novel therapies can be tested.
急性髓系白血病（AML）主要是一种老年疾病，对于老年患者而言，最佳治疗策略仍存在争议。由于担心治疗耐药性，特别是过度毒性甚至治疗相关死亡率，许多老年或身体状况不佳的患者未接受针对AML的治疗。然而，有证据表明，如果基本上所有这些患者都能接受AML治疗，最好是在专门的癌症中心接受治疗，那么治疗结果会得到改善。使用多参数评估工具可以相对准确地估计患者耐受强化化疗的身体状况；这些信息应作为分配强化或非强化治疗的依据。在我们预测个体治疗成功的准确性提高之前，所有患者都应考虑参与随机对照试验。一旦制定出标准化的、改进的反应标准，并确定了可用于测试新疗法的标准治疗方法，将便于对各个试验进行比较。
