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Intensive Chemotherapy May Be Harmful to Most Older Patients With Acute Myeloid Leukemia
Date:7/28/2010

ansplant with blood cells obtained from the circulating blood or cord blood, though, for most elderly patients, the risks of serious side effects eliminate transplant as a viable option.

As most clinical trials of AML thus far have excluded patients older than 55, physicians have had to infer that treatments that work for younger patients will work for older patients, too. In this study, researchers focused on older patients with AML in order to provide more conclusive information about treatment among this population. Researchers analyzed 446 patients with AML age 70 or older who were given a cytarabine-based intensive chemotherapy regimen between 1990 and 2008. For nearly half of the patients, the therapy was successful in combating the cancer, with 45 percent achieving a complete remission. However, 154 patients (some who were in remission as well as some who were not) died during the first eight weeks after treatment began. Causes of death included both treatment toxicity and ineffective therapy leading to disease progression. The researchers analyzed the patients to identify those most at risk for this eight-week mortality rate and found the following predictive factors:

  • age greater than 80 years
  • three or more genetic abnormalities
  • poor performance as indicated by an ECOG score of 2-4 (Developed by the Eastern Cooperative Oncology Group, a score of zero on this scale indicates a fully active individual with no signs of disease, while a score of five indicates death).
  • creatinine levels greater than 1.3 mg (Creatinine levels are an indicator of kidney function, the organ that filters the blood).

The more of these factors patients had, the poorer their survival outcome with intensive chemotherapy. Among those who did not have any of these risk factors (28 percent), only 16 percent had an eig
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SOURCE American Society of Hematology
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