Senior Adult Oncology Program, Moffitt Cancer Center, Tampa, FL, USA.
Division of Leukemia, Department of Hematology & Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, USA.
J Geriatr Oncol. 2024 Mar;15(2):101626. doi: 10.1016/j.jgo.2023.101626. Epub 2023 Sep 21.
Acute myeloid leukemia (AML) treatment is challenging in older patients. There is a lack of evidence-based recommendations for older patients ≥70, a group largely underrepresented in clinical trials. With new treatment options being available in recent years, recommendations are needed for these patients. As such the International Society of Geriatric Oncology (SIOG) assembled a task force to review the evidence specific to treatment and outcomes in this population of patients ≥70 years. Six questions were selected by the expert panel in domains of (1) baseline assessment, (2) frontline therapy, (3) post-remission therapy, (4) treatment for relapse, (5) targeted therapies, and (6) patient reported outcome/function and enhancing treatment tolerance. Information from current literature was extracted, combining evidence from systematic reviews/meta-analyses, decision models, individual trials targeting these patients, and subgroup data. Accordingly, recommendations were generated using a GRADE approach upon reviewing current evidence by consensus of the whole panel. It is our firm recommendation and hope that direct evidence should be generated for patients aged ≥70 as a distinct group in high need of improvement of their survival outcomes. Such studies should integrate information from a geriatric assessment to optimize external validity and outcomes.
急性髓系白血病（AML）治疗在老年患者中具有挑战性。对于年龄≥70 岁的老年患者，缺乏循证推荐，这些患者在临床试验中代表性不足。近年来有了新的治疗选择，因此需要为这些患者提供建议。为此，国际老年肿瘤学会（SIOG）组织了一个工作组，专门审查了针对这一年龄段患者（≥70 岁）的治疗和结局的具体证据。专家小组在以下领域选择了六个问题：（1）基线评估，（2）一线治疗，（3）缓解后治疗，（4）复发治疗，（5）靶向治疗，以及（6）患者报告的结果/功能和提高治疗耐受性。从当前文献中提取信息，将来自系统评价/荟萃分析、决策模型、针对这些患者的单独试验以及亚组数据的证据相结合。因此，通过全体小组成员对现有证据进行审查，使用 GRADE 方法生成了建议。我们强烈建议并希望为年龄≥70 岁的患者作为生存结局急需改善的特殊群体，直接生成证据。这些研究应整合老年评估信息，以优化外部有效性和结局。
