Takeyama H, Yamamoto Y, Miyata Y, Yamada H, Watanabe E, Aoki H, Iinuma M
Dept. of Internal Medicine, Nagoya Ekisaikai Hospital.
Gan To Kagaku Ryoho. 1997 Jul;24(9):1089-93.
We studied fifteen patients older than 80 years of age with acute myelogenous leukemia (AML) treated between 1984 and 1996. Among 15 cases of AML including 7 de novo cases and 8 from myelodysplastic syndrome (MDS) or hypoplastic leukemia, 14 patients had complications, including cardiovascular disease, diabetes mellitus or other malignancies. Although patients with de novo AML showed high peripheral WBC counts and higher cellularity of bone marrow than those from MDS or hypoplastic leukemia, it was difficult in some cases to distinguish these types of AML from hematological findings. Of the 6 AML cases, three had entered complete remission (CR) by a standard dose of combination chemotherapy (BHAC-DMP). One CR patient has had CR for more than 9 years now with good QOL. Among the 3 patients treated by low-dose Ara-C, one attained CR but only for a short period. Four other patients received BRM, such as G-CSF or Ubenimex, and 2 patients died without chemotherapy. Since AML at more than 80 years of age is a highly heterogenous disease, it would be reasonable to give antileukemic agents according to the individual patient's condition.
我们研究了1984年至1996年间接受治疗的15例年龄超过80岁的急性髓性白血病(AML)患者。在15例AML病例中,包括7例初发病例和8例由骨髓增生异常综合征(MDS)或低增生性白血病转化而来的病例,14例患者有并发症,包括心血管疾病、糖尿病或其他恶性肿瘤。尽管初发AML患者的外周血白细胞计数较高,骨髓细胞密度也高于MDS或低增生性白血病患者,但在某些情况下,很难从血液学检查结果中区分这些类型的AML。在6例AML病例中,3例通过标准剂量的联合化疗(BHAC-DMP)达到完全缓解(CR)。1例CR患者至今已维持CR状态超过9年,生活质量良好。在3例接受小剂量阿糖胞苷治疗的患者中,1例达到CR,但仅维持了较短时间。另外4例患者接受了生物反应调节剂(BRM)治疗,如粒细胞集落刺激因子(G-CSF)或乌苯美司,2例患者未接受化疗死亡。由于80岁以上的AML是一种高度异质性疾病,根据个体患者的情况给予抗白血病药物是合理的。