Survival and Response to Treatment Among Elderly Patients with Acute Leukemia

According to a study published in the Annals of Oncology, several patient-related and disease-related characteristics can help predict survival among elderly patients with acute myeloid leukemia (AML).

Acute myeloid leukemia (AML) is a type of cancer in which the bone marrow produces abnormal blood cells or platelets. Since these cells are abnormal, they are not able to perform their normal functions within the body. This may lead to the signs of leukemia, which include anemia, bruising, and infections. Current treatment for AML includes chemotherapy and/or stem cell transplantation.

Although more than half of AML patients are over the age of 60, older patients are underrepresented in clinical trials of treatment regimens. Results of clinical trials, therefore, may not be generalized to the larger population of older patients with AML. In order to evaluate response to treatment and predictors of survival among older patients with AML, researchers in Taiwan conducted a clinical study that evaluated 205 patients age 65 or older with AML who were treated at a single hospital between 1991 and 2003. The researchers evaluated the treatment that the patients had received, results of blood tests, the presence of other illnesses, and the patient’s functional status.

The study identified several factors that were associated with shorter survival among elderly patients with AML. Survival was shorter among patients who had another serious illness, such as heart disease; poor functional status; high levels of lactate dehyrogenase in the blood; high white blood cell levels; or low blood platelet levels. After taking all of these factors into consideration, age was not an important predictor of survival. Based on these factors, researchers classified patients as either “low-risk” or “high-risk.” Low-risk patients survived longer than high-risk patients.

The researchers also evaluated the treatment the patients had received. Patients were treated with one of three general approaches: standard anathracycline-based chemotherapy (a combination cytarabine and either daunomycin or idarubicin); low-dose treatment with cytarabine only; or neither (supportive care to make the patient comfortable). Treatment decisions were based on the patient’s condition and preferences. The results of the study indicate that patients who received standard anthyracycline-based chemotherapy were more likely to experience a complete disappearance of detectable leukemia than patients who received less intensive therapy.

The researchers conclude that several factors can be used to predict survival among elderly AML patients, and that standard anthracycline-based chemotherapy treatment is more likely to produce a complete disappearance of leukemia than less intensive therapy.

Reference: Chen C-C, Yang C-F, Yang M-H et al. Pretreatment prognostic factors and treatment outcome in elderly patients with de novo acute myeloid leukemia. Annals of Oncology. 2005;16:1366-1373.

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