Department of Hematology, Centre Hospitalier Le Mans, 194 Avenue Rubillard, 72000, Le Mans, France.
Department of Hematology, The Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada.
Ann Hematol. 2021 Jun;100(6):1359-1376. doi: 10.1007/s00277-020-04375-x. Epub 2021 Apr 2.
The incidence of acute myeloid leukemia increases with age, and more than half of AML patients are over 60 years old. Treating elderly AML patients presents several challenges and uncertainties, linked partly to disease characteristics and partly to the difficulty of establishing which patients could benefit from the best treatment. Although some elderly fit patients can receive intensive therapy, many of them are not treated and not enrolled in clinical trials. Yet supportive care is associated with significantly lower survival rates compared to intensive therapy or lower intensive therapy. A poorer prognosis in elderly patients is related to age, functional status, and comorbidities, combined with leukemia characteristics. Chronological age is not the best surrogate factor for selecting patients eligible for intensive chemotherapy. Scoring systems-including patient characteristics (ECOG, comorbidities) and disease characteristics (cytogenetics and molecular parameters)-designed to evaluate probabilities of response to treatment, morbidity, and survival may be used to balance the risk-benefit ratio for intensive therapy. A geriatric assessment (GA) to evaluate physical function, comorbidities, nutritional status, cognitive function, and social support could help identify the most vulnerable patients so that they can receive intensive therapy. A GA would also help take the necessary steps to improve tolerance to treatment. Evaluating markers of fitness and quality of life as part of clinical trials should be favored.
急性髓系白血病的发病率随年龄增长而增加，超过一半的 AML 患者年龄在 60 岁以上。治疗老年 AML 患者存在一些挑战和不确定性，部分原因与疾病特征有关，部分原因与确定哪些患者可以从最佳治疗中获益有关。虽然一些身体状况良好的老年患者可以接受强化治疗，但其中许多患者未接受治疗，也未参加临床试验。然而，与强化治疗或低强度强化治疗相比，支持性护理与生存率显著降低相关。老年患者预后较差与年龄、功能状态和合并症有关，同时还与白血病特征有关。年龄不是选择适合强化化疗患者的最佳替代因素。评分系统——包括患者特征（ECOG、合并症）和疾病特征（细胞遗传学和分子参数）——旨在评估对治疗反应、发病率和生存率的可能性，可用于平衡强化治疗的风险效益比。老年评估（GA）可用于评估身体功能、合并症、营养状况、认知功能和社会支持，以帮助确定最脆弱的患者，使他们能够接受强化治疗。GA 还可以帮助采取必要措施提高对治疗的耐受性。在临床试验中评估适应性和生活质量标志物应受到重视。
