Taylor P R, Reid M M, Stark A N, Bown N, Hamilton P J, Proctor S J
Department of Haematology, Royal Victoria Infirmary, Newcastle upon Tyne, UK.
Leukemia. 1995 Feb;9(2):231-7.
A 4-year prospective study of de novo acute myeloid leukaemia in patients aged 56 years and over was undertaken in the Northern Region of England (population 3.09 million). The study was conducted to assess the incidence and outcome of treatment in all elderly patients diagnosed between January 1, 1988 and December 31, 1991. Two hundred cases de novo AML were confirmed, giving an incidence of 6.05/10(5) per annum (age specific population) (95% Cl, 5.2-6.9). Acute promyelocytic leukaemia was rare. Erythroleukaemia, monocytic leukaemia and AML with trilineage myelodysplasia were more common than in younger patients. Karyotypic abnormalities classically associated with response to therapy were present in only six of 91 patients where cytogenetic data was available. Treatment was at the discretion of the physician in charge: if given, specific treatment was recorded and clinical outcome assessed. Only 84 (42%) of patients received treatment with curative intent. Forty-four of 84 achieved a complete remission, usually of brief duration. A normal karyotype in leukaemic cells was associated with a survival advantage in this group (p < 0.05). Actuarial overall survival at 4 years for the entire group was 2.5%. Even with aggressive treatment, the outcome is poor. The pattern of disease and its lack of response to conventional treatment would support the hypothesis that AML in the elderly may differ biologically from that observed in younger patients. Karyotyping appears to predict those patients likely to benefit from intensive therapy and decisions about management in otherwise fit patients should, if possible, be delayed until a result is obtained. Every effort should be made to give such patients optimal treatment. However, most patients are unsuitable for aggressive treatment and, since long-term survival is rare, cure should not be offered as an inducement to accept such treatment and improving quality of life outside hospital should be the aim of treatment in this group.
在英格兰北部地区（人口309万）开展了一项针对56岁及以上患者的新发急性髓系白血病的4年前瞻性研究。该研究旨在评估1988年1月1日至1991年12月31日期间确诊的所有老年患者的发病率和治疗结果。确诊200例新发急性髓系白血病，年发病率为6.05/10⁵（特定年龄人群）（95%可信区间，5.2 - 6.9）。急性早幼粒细胞白血病罕见。红白血病、单核细胞白血病和伴有三系骨髓发育异常的急性髓系白血病比年轻患者更常见。在91例有细胞遗传学数据的患者中，仅有6例存在经典的与治疗反应相关的核型异常。治疗由主管医生自行决定：若进行治疗，则记录具体治疗情况并评估临床结果。仅84例（42%）患者接受了根治性治疗。84例中有44例实现了完全缓解，通常缓解期较短。白血病细胞核型正常在该组患者中具有生存优势（p < 0.05）。整个组4年的精算总生存率为2.5%。即使进行积极治疗，结果仍较差。疾病模式及其对传统治疗缺乏反应支持了这样的假设，即老年急性髓系白血病在生物学上可能与年轻患者不同。核型分析似乎可以预测哪些患者可能从强化治疗中获益，对于其他身体状况合适的患者，有关治疗管理的决策应尽可能推迟至获得结果后再做决定。应尽一切努力为这些患者提供最佳治疗。然而，大多数患者不适合进行积极治疗，由于长期生存罕见，不应将治愈作为诱导患者接受此类治疗的手段，改善院外生活质量应是该组患者的治疗目标。
