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Geriatric Oncology

Acute Myelogenous Leukemia in Older Adults

^aWake Forest University Comprehensive Cancer Center, Winston-Salem, North Carolina, USA; ^bH. Lee Moffitt Cancer and Research Institute, Tampa, Florida, USA

Key Words. Acute myelogenous leukemia • Elderly • Geriatric assessment • Treatment

Correspondence: Heidi D. Klepin, M.D., M.S., Section on Hematology and Oncology, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina 27157, USA. Telephone: 336-716-7975; Fax: 336-716-5687; e-mail: hklepin{at}wfubmc.edu

Received October 10, 2008; accepted for publication February 12, 2009; first published online in THE ONCOLOGIST Express on March 12, 2009.

Disclosures

Heidi D. Klepin: None; Lodovico Balducci:Honoraria: Amgen, Novartis.

Section editors Matti S. Aapro and Arti Hurria have disclosed no financial relationships relevant to the content of this article.

The content of this article has been reviewed by independent peer reviewers to ensure that it is balanced, objective, and free from commercial bias.

Target audience: Physicians who wish to advance their current knowledge of clinical cancer medicine in geriatric oncology.

The incidence of acute myelogenous leukemia (AML) increases with age. Older AML patients, generally defined by age 60 years, have worse treatment outcomes than younger patients. While selected older patients can benefit from standard therapies, as a group they experience greater treatment-related toxicity, lower remission rates, shorter disease-free survival times, and shorter overall survival times. Outcome disparity is in part explained by age-related biologic features. Older patients are more likely to present with unfavorable cytogenetic abnormalities, multidrug resistance phenotypes, and secondary AML. However, even older adults with favorable tumor biology have a worse prognosis than younger patients.

Patient-specific factors, including impaired physical function and comorbidity, independently predict greater treatment toxicity and shorter survival. Improving patient assessment strategies is critical to identify those patients who are most likely to benefit from induction and postremission therapies. In addition, continued efforts to identify more effective and tolerable induction and postremission strategies are needed for this population. Investigations of hypomethylating agents and signal transduction inhibitors hold promise for the treatment of AML patients. Steady advances in the field of hematopoietic transplantation, including use of reduced intensity transplants, may result in additional curative options available to selected older adults. Finally, improved supportive care strategies are needed to maximize treatment outcomes.