Myelodysplastic syndromes and acute myeloid leukemias in the elderly.

Mueller, Beatrice U; Seipel, Katja; Pabst Müller, Thomas Niklaus (2018). Myelodysplastic syndromes and acute myeloid leukemias in the elderly. European journal of internal medicine, 58, pp. 28-32. Elsevier 10.1016/j.ejim.2018.05.026

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Most patients above 60 years with acute myeloid leukemia (AML) will die from their disease. Nevertheless, the treatment concepts in elderly patients with myelodysplastic syndromes (MDS) and AML are rapidly evolving. A number of recent reports have identified better survival rates with intensive induction chemotherapy for patients up to 80 years, with the exception of patients with unfavorable genomic risk abnormalities or with major co-morbidities. Gemtuzumab ozogamicin is increasingly added to induction therapy for AML patients up to 70 years with favorable or intermediate risk profile, and Midostaurin for patients with a FLT3 mutation. The recommended dose of daunorubicin is 60 mg/m for 3 + 7 induction therapy. Elderly patients with acute promyelocytic leukemia should receive all-trans retinoic acid and arsenic trioxide, and cytotoxic treatment is limited upfront to patients with initial leukocytosis. Allogeneic transplantation can be recommended to selected patients up to 70-75 years. For patients unfit for intensive treatment, therapeutic options comprise a hypomethylating agent (HMA), low-dose cytarabin and supportive care. HMA treatment is also increasingly applied for relapsed/refractory AML after intensive chemotherapy. A considerable number of candidate compounds are currently being studied in older AML patients, with their potential role in the treatment of elderly AML patients remaining to be clarified.

Item Type:

Journal Article (Review Article)

Division/Institute:

04 Faculty of Medicine > Department of Haematology, Oncology, Infectious Diseases, Laboratory Medicine and Hospital Pharmacy (DOLS) > Clinic of Medical Oncology

UniBE Contributor:

Seipel, Katja and Pabst Müller, Thomas Niklaus

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1879-0828

Publisher:

Elsevier

Language:

English

Submitter:

Rebeka Gerber

Date Deposited:

28 Feb 2019 16:01

Last Modified:

25 Oct 2019 03:11

Publisher DOI:

10.1016/j.ejim.2018.05.026

PubMed ID:

30527920

Uncontrolled Keywords:

AML Age Chemotherapy Demethylating Elderly Epigenetic Hypomethylating Induction MDS Outcome Prognosis Review Transplantation Treatment

BORIS DOI:

10.7892/boris.124067

URI:

https://boris.unibe.ch/id/eprint/124067

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