From the, Department of Hematology, Oncology and Radiation Physics, Stem Cell Center, Skåne University Hospital, Lund University, Lund, Sweden.
J Intern Med. 2021 Aug;290(2):279-293. doi: 10.1111/joim.13293. Epub 2021 May 5.
The definition of older age in AML is arbitrary. In the context of the clinical studies, it starts with age ≥60 or ≥65 years and in recent years ≥70 or 75, depending on the selection of the studied population. In clinical practice, with older age, we often mean that the patient is unfit for intensive chemotherapy. Higher age overlaps with categories such as worse performance status, unfitness, comorbidities, poor-risk cytogenetics, adverse mutation patterns, age-related clonal haematopoiesis and specific disease ontogeny. Intensive induction therapy can result in prolonged overall survival, at least in a subset of elderly patients aged up to 75 years despite the reluctance of some physicians and patients to use treatment regimens perceived as toxic. Venetoclax and azacitidine combination is the new standard of comparison for persons unfit for intensive therapy. New oral hypomethylating agent CC-486 as maintenance therapy led to a prolonged overall survival in a randomized trial of patients ≥55 years of age who were in first complete remission, but not eligible for allogeneic stem cell transplantation. Any therapy is better than no therapy, but a substantial proportion of older patients still receive only palliative care. Making a decision for AML diagnosed in older age should be individualized and shared through the dialog with the patient and relatives or cohabitants, considering medical issues and social factors including personal goals. Although we are witnesses of the advances in basic research and therapy, we are still a very long way from curing older patients with AML.
AML 中老年人的定义是任意的。在临床研究中，它从年龄≥60 岁或≥65 岁开始，近年来≥70 岁或 75 岁，具体取决于研究人群的选择。在临床实践中，随着年龄的增长，我们通常意味着患者不适合强化化疗。更高的年龄与更差的表现状态、不适合、合并症、不良风险细胞遗传学、不良突变模式、与年龄相关的克隆性造血和特定疾病发生学等类别重叠。强化诱导治疗可以导致总生存期延长，至少在年龄高达 75 岁的一部分老年患者中如此，尽管一些医生和患者不愿意使用被认为有毒的治疗方案。维奈托克和阿扎胞苷联合治疗是不适合强化治疗者的新标准。新的口服低甲基化药物 CC-486 作为维持治疗，在一项随机试验中，在年龄≥55 岁、处于首次完全缓解但不适合异体干细胞移植的患者中，导致总生存期延长。任何治疗都优于不治疗，但很大一部分老年患者仍只接受姑息治疗。对诊断为老年 AML 的患者做出决策应该个体化，并通过与患者及其亲属或同居者进行对话来共同做出决策，考虑医疗问题和社会因素，包括个人目标。尽管我们见证了基础研究和治疗的进展，但我们离治愈老年 AML 患者还有很长的路要走。
