Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
University Hospital, Dept of Hematology, Oncology and Rheumatology, Heidelberg, Germany.
J Geriatr Oncol. 2020 Nov;11(8):1199-1209. doi: 10.1016/j.jgo.2020.03.019. Epub 2020 Apr 6.
Approximately one third of patients diagnosed with acute promyelocytic leukemia (APL) are above the age of sixty. It is important to ensure older adults receive optimal diagnosis and management since this subtype of acute myeloid leukemia - given appropriate treatment - is highly curable with lower risk of adverse events compared to other types of leukemia. Historically, older age has been a risk factor for early death and poorer overall survival. However, prospects have changed with the introduction of all-trans retinoic acid (ATRA) and arsenic trioxide (ATO). APL is curable in the majority of patients regardless of age, and the threshold of fitness that makes ATRA/ATO therapy possible is likely to be lower than for cytotoxic chemotherapy. APL frequently presents as a medical emergency and rapid diagnosis and intervention - typically involving referral to a specialist centre - is a major determinant of outcome. After diagnosis, management of APL in older adults presents particular challenges. Geriatric assessment, including evaluation of frailty, comorbidities and polypharmacy can assist in providing optimal supportive care for older adults during remission induction and may help individualize therapy in the post-remission phase. Here, we review the available evidence, highlighting areas of consensus, gaps in evidence and opportunities for research to enhance diagnosis, management and survivorship for older patients.
约三分之一被诊断为急性早幼粒细胞白血病（APL）的患者年龄在 60 岁以上。由于这种类型的急性髓细胞白血病在适当治疗后，与其他类型的白血病相比，具有更高的治愈率和更低的不良事件风险，因此确保老年人获得最佳诊断和治疗非常重要。从历史上看，年龄较大是导致早期死亡和整体生存率较差的危险因素。然而，随着全反式维甲酸（ATRA）和三氧化二砷（ATO）的引入，情况发生了变化。无论年龄大小，大多数患者都可以治愈 APL，并且使 ATRA/ATO 治疗成为可能的健康状况阈值可能低于细胞毒性化疗。APL 常表现为急症，快速诊断和干预——通常包括转诊至专科中心——是决定预后的主要因素。诊断后，老年 APL 的治疗具有特殊的挑战。老年评估，包括对虚弱、合并症和多药治疗的评估，有助于在缓解诱导期间为老年人提供最佳的支持性护理，并可能有助于在缓解后阶段个体化治疗。在这里，我们回顾了现有证据，强调了共识领域、证据差距和研究机会，以提高老年患者的诊断、管理和生存能力。
