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Berdel (Abstract)

Cellular Therapy and Transplantation (CTT), Vol. 3, No. 12
doi: 10.3205/ctt-2011-No12-abstract75

© The Authors. This abstract is provided under the following license: Creative Commons Attribution 3.0 Unported

Abstract accepted for "5th Raisa Gorbacheva Memorial Meeting Hematopoietic Stem Cell Transplantation in Children and Adults", Saint Petersburg, Russia, September 18–20, 2011

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AML in the elderly patient: roadblocks and outlook

Wolfgang E. Berdel

Department of Medicine A – Hematology/Oncology, University Hospital of Muenster, Germany

Correspondence: Wolfgang E. Berdel, Department of Medicine A University Hospital Muenster Westfaelische Wilhelms-University, D-48129, Muenster, Germany, Email: berdel@spam is baduni-muenster.de

Abstract

The majority of patients with acute myeloid leukemia (AML) are diagnosed at an age >60 years. Their prognosis is unfavorable. Age is an adverse prognostic factor in various prognostic subgroups of AML as shown e.g., in the AMLCG 1992 and 1999 trials. Using current treatment protocols, 5-year survival is ≤20% and treatment results have shown only little improvement over the last 15 years. In particular, international and our AMLCG data show that the impact of further dose escalation of the chemotherapeutic drugs used today in remission induction or in post-remission therapy is limited. How can we proceed? The European Study Alliance Leukemia (SAL) decided to “interview” molecules and molecular pathways with potential impact on leukemia biology with new drugs added to the standard treatment of a 7+3 type ara C plus anthracycline-containing protocol as 1st line treatment in randomized phase II trials. Three study types are used. Study type 1 has replaced one of the drugs in the 7+3 regimen by a new drug in the 1st cycle. As an example, the results of the “7+Gemtuzumab ozogamicin” trial are presented. Study type 2 adds a new drug to the 7+3 regimen, which blocks molecules and pathways with potential leukemia-driving impact. Here, the results of a randomized Sorafenib trial are presented and an overlook on current and future trials of the SAL is given. Further, SAL and AMLCG have developed a WEB-based AML-score (http://www.AML-score.org), which may help decide whether a patient should or should not be treated with combination chemotherapy at all. Study type 3 tests single drug approaches (e.g., low dose ara C) plus a new experimental drug in a randomized fashion in frail patients not fit for combination chemotherapy. Drug candidates for these studies are discussed. Finally, some patients at an age 60 years are in very good physical condition and are even candidates for allogeneic bone marrow stem cell transplantation (BMT). A series of 77 AML patients 60 years, 43% of those in remission and 57% suffering from refractory disease with residual AML blasts, underwent BMT in our center. The overall survival at 3 years is 45% with disease status (remission vs. refractory) and age within this group being prognostic.

Keywords: Acute myeloid Leukemia, AML, elderly patients, prognosis, recent studies, Study Alliance Leukemia, SAL