Management of elderly patients (older than 60 yrs of age)

Older patients who present with AML have a poorer prognosis (probably worsens with each year of increasing age), more unfavourable cytogenetic abnormalities, higher incidence of secondary leukaemia and increased frequency of overexpression of multidrug resistance (MDR) phenotypes (1,2).

These patients require different treatment approaches since treatment in this group is associated with an increased resistance to chemotherapy, increased treatment-related complications and an inferior outcome (1).

It is important to consider the performance status or various comorbidities before treatment since this permit some flexibility over the age cutoffs (1).

Management options in this group include:

• standard chemotherapy
  • is considered in patients with the following features:
    • relatively young age (60-70 years)
    • good performance status (WHO grade 0-2)
    • white cell count <100 x 10^9/l
    • normal organ function
    • de novo presentation
    • lack of unfavourable cytogenetic abnormalities
    • lack of MDR gene expression
• non-intensive (palliative) treatment
  • the aim is to control the WBC count and to minimise hospitalisation and to improve quality of life

Reference:

• 1. British Committee for Standards in Haematology et al.Guidelines on the management of acute myeloid leukaemia in adults. Br J Haematol. 2006;135(4):450-74.
• 2. Döhner H et al. Diagnosis and management of acute myeloid leukemia in adults: recommendations from an international expert panel, on behalf of the European LeukemiaNet. Blood. 2010;115(3):453-74.