Schiller G J
Division of Hematology/Oncology, University of California Los Angeles School of Medicine 90095, USA.
Leukemia. 1996 Apr;10 Suppl 1:S18-20.
Acute myeloid leukemia (AML) in people over age 60 is characterized by adverse cytogenetic characteristics, prior myelodysplasia, and phenotypic features predictive of poor response to induction chemotherapy and brief leukemia-free survival. Because increased treatment-related toxicity complicates both induction and consolidation chemotherapy, most studies of AML in the elderly focus on induction regimens designed to reduce toxicity. Consolidation usually consists of a repeat cycle of conventional-dose induction chemotherapy. Older patients who achieve complete remission may represent a select population, clinically distinct from patients receiving induction therapy. Regardless of the consolidation regimen, the duration of complete remission is 3 months to 11 months, with long-term leukemia-free survival rates of 10 percent to 28 percent. In the UCLA experience, patients over age 60 who received consolidation, chemotherapy and pretreatment characteristics similar to elderly patients undergoing induction. Postremission treatment varied from standard-dose ara-C to high-dose ara-C consolidation followed by autologous stem-cell transplantation. Leukemia-free survival appears to be longer with high-dose ara-C and autologous stem-cell transplantation. Further randomized studies should be conducted to determine the feasibility of and response to postremission treatment.
60岁以上人群的急性髓系白血病（AML）具有不良细胞遗传学特征、既往骨髓增生异常以及预示诱导化疗反应不佳和白血病无进展生存期短暂的表型特征。由于治疗相关毒性增加使诱导化疗和巩固化疗都变得复杂，大多数针对老年人AML的研究都集中在旨在降低毒性的诱导方案上。巩固治疗通常包括重复一个常规剂量诱导化疗周期。实现完全缓解的老年患者可能代表一个特定人群，在临床上与接受诱导治疗的患者不同。无论巩固方案如何，完全缓解的持续时间为3个月至11个月，长期无白血病生存率为10%至28%。在加州大学洛杉矶分校的经验中，60岁以上接受巩固治疗的患者，化疗和预处理特征与接受诱导治疗的老年患者相似。缓解后治疗从标准剂量阿糖胞苷到高剂量阿糖胞苷巩固治疗，随后进行自体干细胞移植不等。高剂量阿糖胞苷和自体干细胞移植似乎可使无白血病生存期更长。应进行进一步的随机研究，以确定缓解后治疗的可行性和反应。
