ACUTE MYELOID-LEUKEMIA IN THE ELDERLY - BIOLOGY AND TREATMENT
ACUTE MYELOID-LEUKEMIA IN THE ELDERLY - BIOLOGY AND TREATMENT
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DOI：
10.1111/j.1365-2141.1993.tb04622.x
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发表时间：
1993-01-01
影响因子：
6.5
通讯作者：
YIN, AL
中科院分区：
文献类型：
--
作者：
JOHNSON, PRE;YIN, AL
通过改善支持性护理和非常密集的化疗，无论是否进行骨髓移植，现在都有可能治愈越来越多的急性髓性白血病（AML）年轻患者。然而，约60%的AML患者年龄超过60岁（Brinker，1982）。而且对这些老年病人的管理通常不能令人满意。因此，现在是及时审查的具体问题，老年患者与急性髓细胞白血病构成。流行病学在英国，AML的年发病率随着年龄的增长呈指数上升，从30岁以下患者中的每100000人中不到1例，到70岁以上患者中的每100000人中超过10例（Cartwright等，1990）。此外，1991年联合王国的人口为5，760万，其中约有1，190万（20.7%）年龄在60岁以上。到2031年，预计总人口将达到6 130万（增长6.4%），其中1 650万（增长38.2%）年龄在60岁以上（OPCS，1991年）。如果白血病发病率在此期间保持不变，则根据英国白血病研究基金流行病学数据（Cart-Wright et al. 1990）推断这些人口统计学变化，预计到2031年AML病例将增加20.5%。这一数字包括60岁以下病例减少1.7%，但60-74岁病例增加37.8%，75岁以上病例增加39%。这些变化将在未来40年内对老年AML患者的管理产生重大的医疗和财务影响。所有AML患者的中位年龄为64岁（Brinker，1982）。在最近的治疗试验中，平均年龄约为50岁，范围为44 - 53岁（Champkn等，1987; Rees和Gray，1990）。这种倾向于排除老年患者的预选（图1），显然导致了对缓解率的过度乐观的报道（多伦多白血病研究组，1986）。
With improved supportive care and very intensive chemotherapy, with or without bone marrow transplantation, it is now possible to cure an increasing number of younger patients with acute myeloid leukaemia (AML). However, approximately 60% of patients with AML are over 60 years old (Brinker, 1982). and the management of such elderly patients has been generally unsatisfactory. Thus it is timely to review the specific problems which elderly patients with AML pose. and discuss the various treatment modalities currently available.Epidemiology The annual incidence of AML in the United Kingdom rises exponentially with increasing age from less than 1 per IOOOOOl in patients under 30, to over 10 per 100000 in patients over 70 (Cartwright et al, 1990). Furthermore, while in 1991 the population of the United Kingdom was 57.6 million, with approximately 11.9 million (20.7%) over the age of 60. in 2031 the projected total population will be 61.3 million (an increase of 6.4%), with 16.5 million (an increase of 38.2%) over the age of 60 (OPCS, 1991). If leukaemia incidence remains static over this period, extrapolation of UK Leukaemia Research Fund epidemiology data (Cart-Wright et al. 1990) to these demographic changes projects a 20.5% increase in cases of AML by 2031. This figure comprises a reduction of 1.7% in cases under 60 years old, but an increase of 37.8% in cases aged 60-74, and 39% in cases over 75 years old. These changes will have major medical and financial implications for the management of elderly patients with AML over the next 40 years. Whilst the median age of all patients with AML is 64 years (Brinker, 1982). the median age in recent treatment trials is approximately 50 years with a range from 44 to 53 years (Champkn et al. 1987; Rees & Gray, 1990). Such preselection, tending to exclude older patients (Fig l), clearly results in the reporting of over-optimistic remission rates (Toronto Leukaemia Study Group, 1986).