Smoldering acute myelogenous leukemia in the elderly

Out of 75 consecutive elderly AML patients who did not receive anti-leukemi c treatment (52pts) or failed to respond to differentiating agent (23pts), 6 patients had survivals of 13.2 to 98 months with treatment restricted to supportive care. This cut-point is far longer than the median survival of t he 235 elderly patients (3.5mo.), either untreated (med. survival: 1mo.) or treated (with treatment ranging from conventional induction to palliative chemotherapy) (4mo.), admitted to our department within the same period of time. These cases of smoldering AML (4 women, 2 men) were all of AML2 FAB s ubtype (4 de novo, 2 post MDS) and presented with a significantly better pe rformance status, lower WBC and circulating blast counts, higher platelet c ounts and with lower bone marrow infiltration than AML cases with more rapi d progression. Cytogenetical analysis when available (3pts) showed normal k aryotypes and clonogenic assay performed in 3 of these patients showed a la ck of (2pts) or reduced irt vitro leukemic cell growth (1pt). The identification of specific characteristics df smoldering leukemia in th e elderly might be an important development in the understanding of the phy siopathology of acute leukemia and a tool for helping decision-making when selecting the time and intensity of cytotoxic treatment in these older pati ents.