Ematologia, Dipartimento di Biomedicina e Prevenzione, Università di Roma "Tor Vergata", Rome, Italy.
Dipartimento Ematologia, Oncologia e Medicina Molecolare, ASST Grande Ospedale Metropolitano Niguarda-Milano, Milan, Italy.
Expert Rev Hematol. 2023 Mar;16(3):181-190. doi: 10.1080/17474086.2023.2185603. Epub 2023 Mar 8.
Age has historically been considered the main criterion to determine eligibility for intensive chemotherapy in patients with acute myeloid leukemia (AML), but age alone can no longer be considered an absolute indicator in determining which patients should be defined as unfit. Assessment of fitness for a given treatment today serves an important role in tailoring therapeutic options.
This review examines the main options used in real life to define eligibility for intensive and nonintensive chemotherapy in patients with AML, with a main focus on the Italian SIE/SIES/GITMO Consensus Criteria. Other published real-life experiences are also reviewed, analyzing the correlation between these criteria and short-term mortality, and thus expected outcomes.
Assessment of fitness is mandatory at diagnosis to tailor treatment to the greatest degree possible, evaluating the patient's individual profile. This is especially relevant when considering the availability of newer, less toxic therapeutic regimens, which have shown promising results in patients with AML who are older or considered unfit for intensive treatment. Fitness assessment is now a fundamental part of AML management and a critical step that can potentially influence outcomes and not just predict them.
在急性髓系白血病（AML）患者中，年龄一直被认为是决定接受强化化疗的主要标准，但仅凭年龄已不能作为确定哪些患者不适合治疗的绝对指标。目前，对治疗适应性的评估在制定治疗方案方面发挥着重要作用。
本文回顾了在 AML 患者中定义强化和非强化化疗适应证的主要实用选择，重点介绍了意大利 SIE/SIES/GITMO 共识标准。还回顾了其他已发表的真实临床经验，分析了这些标准与短期死亡率之间的相关性，以及由此预测的治疗效果。
在诊断时评估患者的身体状况对于尽可能地制定个体化治疗方案非常重要。这在考虑到更新、毒性更低的治疗方案时尤为重要，这些方案在年龄较大或被认为不适合强化治疗的 AML 患者中显示出了良好的效果。目前，对身体状况的评估已成为 AML 管理的重要组成部分，是一个潜在影响治疗效果的关键步骤，而不仅仅是预测。
