Acute myeloid leukaemia (AML):: treatment of the older patient
Acute myeloid leukaemia (AML):: treatment of the older patient
复制标题
DOI：
10.1053/beha.2000.0120
复制
发表时间：
2001-03-01
影响因子：
2.1
通讯作者：
Heinecke, A
中科院分区：
文献类型：
--
作者：
Büchner, T;Hiddemann, W;Heinecke, A
老年急性髓性白血病（AML）患者治疗不足可以部分解释他们与年轻患者相比预后较差的原因。与60岁以下患者从高剂量Ara-C中获益相对应，60岁以上患者也存在剂量效应，特别是诱导治疗中的柔红霉素，以及缓解后治疗持续时间的数量。使用这些效应可以部分克服在老年AML患者中观察到的大多数不利的疾病生物学，其表现为缺乏有利的和过度代表的不良染色体异常以及耐药性的表达。我们建议给予足够剂量的柔红霉素60 mg/m2，持续3天，联合标准剂量的阿糖胞苷和6-硫鸟嘌呤进行诱导和巩固，随后每月进行一次维持化疗，持续至少1年。支持性治疗的进一步改善可能有助于提供额外的抗白血病细胞毒性。作为一种新的方法，非清髓性预处理方案可能为老年AML患者开辟异基因移植的领域。鉴于这种疾病的实际中位年龄超过60岁，老年AML的管理仍然是主要挑战。
Undertreatment of the older patients with acute myeloid leukaemia (AML) can explain, in part, their inferior outcome when com pared with that of younger patients. Corresponding to the benefit to patients under the age of 60 from high-dose Ara-C there are also dose effects in those over 60 years old, in particular for daunorubicin in the induction treatment, and for the quantity in terms of duration of postremission treatment. The use of these effects can partly overcome the mostly unfavourable disease biology seen in older age AML patients, which is expressed by the absence of favourable and the over-representation of adverse chromosomal abnormalities as well as by the expression of drug resistance. We recommend an adequate dosage of 60 mg/m(2) daunorubicin for 3 days in combination with standard dose Ara-C and 6-thioguanine given for induction and consolidation, followed by a prolonged monthly maintenance chemotherapy for a duration of at least 1 year. Further improvements in supportive care may help in delivering additional anti-leukaemic cytotoxicity. As a novel approach, non-myeloablative preparative regimens may open up the field of allogeneic transplantation for older patients with AML. Given that the actual median age in this disease is more than 60 years the management of older age AML remains as the major challenge.