Wang Eunice S
Leukemia Service, Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY.
Hematology Am Soc Hematol Educ Program. 2014 Dec 5;2014(1):14-20. doi: 10.1182/asheducation-2014.1.14. Epub 2014 Nov 18.
Acute myeloid leukemia (AML) is a disease of older adults, with a median age of 67 years at presentation. In the past, only a third of older patients (defined as individuals older than 60-65 years of age) with AML received definitive therapy for their disease due to concerns about their overall fitness and potential treatment-related mortality. However, compelling epidemiological data have shown unequivocally that older AML patients up to 80 years old both tolerate and survive longer after therapy than their untreated counterparts. Current therapeutic options for elderly individuals with AML include intensive chemotherapy with a cytarabine and anthracycline backbone, hypomethylating agents (decitabine and azacitidine), low-dose cytarabine, investigational agents, and supportive care with hydroxyurea and transfusions. Over the last few years, there has been increasing debate regarding the appropriate therapeutic approach to take in older adults given the diversity of the geriatric patient population and heterogeneous AML disease biology. This article discusses how performance status, comorbidities, disease characteristics, quality of life concerns, and long-term treatment goals affect the selection of appropriate therapy for older adults with AML. Risks and benefits of each treatment approach based on the most recent medical literature are discussed. Finally, a treatment algorithm summarizing these data and incorporating geriatric assessment and molecular and cytogenetic markers predictive of therapeutic response is proposed to aid in the clinical decision-making process.
急性髓系白血病（AML）是一种好发于老年人的疾病，确诊时的中位年龄为67岁。过去，由于担心老年患者（定义为年龄大于60 - 65岁的个体）的整体健康状况以及潜在的治疗相关死亡率，仅有三分之一的老年AML患者接受了针对其疾病的确定性治疗。然而，令人信服的流行病学数据明确显示，80岁及以下的老年AML患者在接受治疗后比未接受治疗的患者耐受性更好，生存期更长。目前，老年AML患者的治疗选择包括以阿糖胞苷和蒽环类药物为主的强化化疗、去甲基化药物（地西他滨和阿扎胞苷）、小剂量阿糖胞苷、研究性药物，以及使用羟基脲和输血的支持性治疗。在过去几年中，鉴于老年患者群体的多样性和AML疾病生物学的异质性，对于老年患者应采取何种合适的治疗方法的争论日益激烈。本文讨论了体能状态、合并症、疾病特征、生活质量问题以及长期治疗目标如何影响老年AML患者合适治疗方案的选择。基于最新医学文献，讨论了每种治疗方法的风险和益处。最后，提出了一种治疗算法，总结这些数据并纳入老年评估以及预测治疗反应的分子和细胞遗传学标志物，以辅助临床决策过程。
