Löwenberg B
Afd Hematologie, Academisch Ziekenhuis Rotterdam-Daniel den Hoed Kliniek.
Ned Tijdschr Geneeskd. 1997 Nov 8;141(45):2157-9.
More than 50% of patients with acute myelogenous leukaemia are 60 years or older. Unlike the results of treatment of younger adults, the outcome in patients of higher age has been disappointing because intensive chemotherapy is tolerated less well, complications due to cardiac and pulmonary comorbidity occur sooner, toxicity due to reduced hepatic and renal function occurs earlier and older patients often present with leukaemia that is intrinsically of higher risk (e.g. unfavourable cytogenetics). Remission-induction therapy with an anthracycline derivative and cytarabine results in complete remission rates of approximately 50% in older patients; 15-20% of these remain free of leukaemia beyond 2-3 years and have a good quality of life. The clinical use of hematopoietic growth factors as adjuncts to chemotherapy to reduce complications and improve survival has not (yet) fulfilled his promise. By selecting older patients without major comorbidity for therapy and assessing the response to a first cycle of chemotherapy one may identify patients with the best response to treatment and avoid continued therapy in patients with poor prognosis. In this way the choice of treatment of the individual older patient can be optimized.
超过50%的急性髓系白血病患者年龄在60岁及以上。与年轻成人的治疗结果不同，高龄患者的治疗结果令人失望，因为强化化疗耐受性较差，心脏和肺部合并症导致的并发症出现更早，肝肾功能下降导致的毒性出现更早，而且老年患者常表现出本质上风险更高的白血病（如不良细胞遗传学）。使用蒽环类衍生物和阿糖胞苷进行缓解诱导治疗，老年患者的完全缓解率约为50%；其中15 - 20%在2 - 3年以上无白血病，生活质量良好。造血生长因子作为化疗辅助手段以减少并发症和提高生存率的临床应用尚未实现其承诺。通过选择无严重合并症的老年患者进行治疗，并评估对第一个化疗周期的反应，可以识别出对治疗反应最佳的患者，并避免对预后不良的患者继续治疗。这样可以优化个体老年患者的治疗选择。
