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Geriatric Oncology

Current and Emerging Strategies for the Management of Acute Myeloid Leukemia in the Elderly

Division of Medical Oncology, Duke University Medical Center, Durham, North Carolina, USA

Key Words. Acute myeloid leukemia • Elderly • Chemotherapy • Gemtuzumab ozogamicin • Bone marrow transplantation

Correspondence: Arati V. Rao, M.D., 111G, 508 Fulton Street, Durham, North Carolina 27705, USA. Telephone: 919-286-6944; Fax: 919-286-6896; e-mail: rao00012{at}mc.duke.edu

Received April 21, 2008; accepted for publication August 18, 2008; first published online in THE ONCOLOGIST Express on October 15, 2008.

Disclosure: The content of this article has been reviewed by independent peer reviewers to ensure that it is balanced, objective, and free from commercial bias. No financial relationships relevant to the content of this article have been disclosed by the authors, planners, independent peer reviewers, or staff managers.

Acute myeloid leukemia (AML) accounts for approximately 80% of acute leukemias diagnosed in adults. The elderly are disproportionately affected by AML, as 35% of newly diagnosed patients are aged 75 and the median age at diagnosis is 67. Elderly individuals also respond less well to standard chemotherapy than do younger individuals, as reflected by lower complete remission and relapse-free survival rates in major clinical trials. A higher prevalence of comorbid conditions as well as the unique biological features of elderly AML patients account for the relatively poor response to therapy observed in this population. Compared with AML in younger individuals, for example, AML in the elderly more often emerges from a preceding myelodysplastic syndrome and is more frequently associated with poor-prognosis karyotypes such as 5q– or 7q–. The introduction of novel therapies over the past decade has already altered the treatment paradigm of elderly individuals with AML. The first of these to emerge was gemtuzumab ozogamicin. Other agents are currently under evaluation in clinical trials, including inhibitors of multidrug resistance, farnesyltransferase inhibitors, novel nucleoside analogues, and inhibitors of the FMS-like tyrosine kinase-3. This review describes the biological features of AML in the elderly and summarizes both the current and emerging strategies for the treatment of this disease in older individuals.