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Annals of Oncology Advance Access published online on June 14, 2005
Annals of Oncology, doi:10.1093/annonc/mdi259
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© 2005 European Society for Medical Oncology
Received January 10, 2005
Revised April 28, 2005
Accepted April 29, 2005

Original article

Pretreatment prognostic factors and treatment outcome in elderly patients with de novo acute myeloid leukemia

C.-C. Chen 1, C.-F. Yang 2, M.-H. Yang 3, K.-D. Lee 4, W.-K. Kwang 2, J.-Y. You 5, Y.-B. Yu 5, C.-H. Ho 5, C.-H. Tzeng 6, W.-K. Chau 5, H.-C. Hsu 5, and J.-P. Gau 7*

1 Division of Hematology Oncology, Department of Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan Division of Hematology, Department of Medicine, Taipei, Taiwan
2 Department of Pathology, Veterans General Hospital; Taipei, Taiwan National Yang-Ming University School of Medicine, Taipei, Taiwan
3 Division of Oncology, Department of Medicine, Taipei, Taiwan, National Yang-Ming University School of Medicine, Taipei, Taiwan
4 Division of Hematology Oncology, Department of Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
5 Division of Hematology, Department of Medicine, Taipei, Taiwan, National Yang-Ming University School of Medicine, Taipei, Taiwan
6 Division of Transfusion Medicine, Department of Medicine, Taipei, Taiwan and National Yang-Ming University School of Medicine, Taipei, Taiwan
7 Division of Hematology, Department of Medicine, Taipei, Taiwan, National Yang-Ming University School of Medicine, Taipei, Taiwan

* To whom correspondence should be addressed.
J.-P. Gau, E-mail: jpgau{at}vghtpe.gov.tw


  Abstract

Background: Elderly patients with acute myeloid leukemia (AML) generally have an unfavorable clinical course and are under-represented in clinical trials. The aim of this study was to analyze the prognosis and treatment outcome of elderly AML patients.

Patients and methods: We studied 205 AML patients aged 65 years or older at our hospital. Prior to study initiation, we designated 13 variables to be analyzed for their impact on complete remission (CR) rate and overall survival (OS).

Results: Induction regimen (standard chemotherapy) and good performance status (PS) (Eastern Cooperative Oncology Group PS 0-1) independently influenced the achievement of CR. Multivariate analysis also determined five poor prognostic factors for OS: poor PS (score 2-4), presence of comorbidities, elevated serum lactate dehydrogenase level (≥2x upper normal limit), extreme leukocytosis (≥100 x 109/l) and marked thrombocytopenia (≤20 x 109/l). Age was not an independent contributing factor in terms of either CR attainment or OS duration. Low-risk patients, who possessed one or less non-leukocytosis poor prognostic factor, had significantly longer disease-free survival and OS than their high-risk counterparts.

Conclusions: Elderly AML patients should be risk-stratified at diagnosis. Anthracycline-based induction chemotherapy would be the best therapeutic option for such patients.

Keywords: AML; elderly; prognosis; treatment.
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