Krug Utz, Gale Robert Peter, Berdel Wolfgang E, Müller-Tidow Carsten, Stelljes Matthias, Metzeler Klaus, Sauerland M Cristina, Hiddemann Wolfgang, Büchner Thomas
Klinikum Leverkusen, Department of Medicine 3, Am Gesundheitspark 11, 51375 Leverkusen, Germany.
Haematology Research Centre, Division of Experimental Medicine, Department of Medicine, Imperial College London, London, UK.
Leuk Res. 2017 Sep;60:1-10. doi: 10.1016/j.leukres.2017.05.020. Epub 2017 Jun 1.
Most persons age≥60 y with acute myeloid leukaemia (AML) die from their disease. When interpreting clinical trials data from these persons one must be aware of substantial selection biases. Randomized trials of post-remission treatments can be performed upfront or after achieving defined landmarks. Both strategies have important limitations. Selection of the appropriate treatment is critical. Age, performance score, co-morbidities and frailty provide useful data to treatment selection. If an intensive remission induction therapy is appropriate, therapy with cytarabine and an anthracycline is the most common regimen. Non-intensive therapies consist of the hypo-methylating drugs azacitidine and decitabine, low-dose cytarabine and supportive care. Feasibility of doing an allotransplant in older persons with AML is increasing. However, only very few qualify. Results of cytogenetic testing are risk factor in young and old persons with AML. Adverse abnormalities are more frequent in older persons. Although data about the frequency of mutations in older persons with AML is increasing their prognostic impact is less clear than in younger subjects. Neither differences in the distribution of cytogenetic risk, mutations, nor differences in clinical risk factors between younger and older persons with AML completely explain the age-dependent outcome. Many drugs are in clinical development in older persons with AML. Their potential role in the treatment of older persons with AML remains to be defined.
大多数年龄≥60岁的急性髓系白血病（AML）患者死于该疾病。在解读这些患者的临床试验数据时，必须意识到存在大量的选择偏倚。缓解后治疗的随机试验可以在治疗开始时或达到特定里程碑后进行。这两种策略都有重要的局限性。选择合适的治疗方法至关重要。年龄、体能状态评分、合并症和虚弱程度为治疗选择提供了有用的数据。如果强化缓解诱导治疗合适，阿糖胞苷和蒽环类药物联合治疗是最常见的方案。非强化治疗包括低甲基化药物阿扎胞苷和地西他滨、小剂量阿糖胞苷及支持治疗。老年AML患者进行异基因移植的可行性正在增加。然而，只有极少数患者符合条件。细胞遗传学检测结果是年轻和老年AML患者的危险因素。不良异常在老年人中更常见。尽管关于老年AML患者突变频率的数据不断增加，但其对预后的影响不如年轻患者明确。年轻和老年AML患者在细胞遗传学风险分布、突变以及临床危险因素方面的差异都不能完全解释年龄依赖性结局。许多药物正在针对老年AML患者进行临床研发。它们在老年AML患者治疗中的潜在作用仍有待确定。
