DE-NOVO ACUTE MYELOID-LEUKEMIA IN PATIENTS OVER 55-YEARS-OLD - A POPULATION-BASED STUDY OF INCIDENCE, TREATMENT AND OUTCOME

A 4-year prospective study of de novo acute myeloid leukaemia in patie nts aged 56 years and over was undertaken in the Northern Region of En gland (population 3.09 million). The study was conducted to assess the incidence and outcome of treatment in all elderly patients diagnosed between January 1, 1988 and December 31, 1991. Two hundred cases de no vo AML were confirmed, giving an incidence of 6.05/10(5) per annum (ag e specific population) (95% CI, 5.2-6.9). Acute promyelocytic leukaemi a was rare. Erythroleukaemia, monocytic leukaemia and AML with triline age myelodysplasia were more common than in younger patients. Karyotyp ic abnormalities classically associated with response to therapy were present in only six of 91 patients where cytogenetic data was availabl e. Treatment was at the discretion of the physician in charge: if give n, specific treatment was recorded and clinical outcome assessed. Only 84 (42%) of patients received treatment with curative intent. Forty-f our of 84 achieved a complete remission, usually of brief duration. A normal karyotype in leukaemic cells was associated with a survival adv antage in this group (p < 0.05). Actuarial overall survival at 4 years for the entire group was 2.5%. Even with aggressive treatment, the ou tcome is poor. The pattern of disease and its lack of response to conv entional treatment would support the hypothesis that AML in the elderl y may differ biologically from that observed in younger patients. Kary otyping appears to predict those patients likely to benefit from inten sive therapy and decisions about management in otherwise fit patients should, if possible, be delayed until a result is obtained. Every effo rt should be made to give such patients optimal treatment. However, mo st patients are unsuitable for aggressive treatment and, since long-te rm survival is rare, cure should not be offered as an inducement to ac cept such treatment and improving quality of life outside hospital sho uld be the aim of treatment in this group.