Acute Myeloid Leukemia in the Elderly, Intensive or Maintenance Therapy? Our Experience in Patients Over 65 Years
When AML develops in people over the age of 65, the optimal choice of therapy is debatable. Intensive chemotherapy for AML is highly toxic, and there is great concern over causing more harm than good with this regimen. Many of these patients thus end up treated with a maintenance program of less toxic therapy. This study looked at 54 patients with AML , ages ranging from 66 to 90. Twenty seven patients were treated with an intensive regimen of Fludarabine, Ara-C, and G-CSF (Flag) and mitoxantrone, cytarabine and etoposide (MICE). The median age of these patients was 71 years. Twenty seven patients were treated with maintenance therapy with low dose cytarabine and/or supportive care.
Twelve patients (45%) in the intensive chemotherapy group went into remission in response to treatment, giving an overall survival of 7.15 months. In the group of patients who received maintenance therapy, 30% (eight patients) went into remission and the overall survival was 4.94 months. This difference was not statistically significant.
While this study's authors reported a trend toward improved survival with the intensive chemotherapy, there are some issues with the study's methods. It is not clear if this was a randomized study. It is possible that sicker or more elderly patients were given the maintenance therapy, which would likely make the intensive chemotherapy group appear to have better outcomes. In addition, the toxicities experienced by the groups were not reported, so it is hard to address quality of life issues and the causes of death for the groups. In addition, there are several newer agents being tested and/ or used in older AML patients that should be included in any larger trials looking at therapy for older patients.