De novo and secondary acute myeloid leukemia in patients over the age of 65: a review of fifty-six successive and unselected cases from a general hospital

Fifty-six patients older than 65 (median age: 77, range: 65-91) were treate d in our general hospital, between January 1991 and November 1995 with the diagnosis of AML, Twenty-five were de novo AML (45%), The other cases which were considered as secondary AML (sAML) occurred after: myelodysplastic sy ndromes (19 cases: 34%), myeloproliferative dis orders (7: 13%) or therapy of malignancies (5: 9%). Distribution of FAB subtypes was: MO: 4, M1: 8, M2 : 14, M4: 10, M4eo: 1, M5: 10, M6: 1, unclassified: 8. Twenty-seven patient s (48%) (de novo, 18, sAML: 9) received conventional "3 + 5" or "3 +7" indu ction chemotherapy +/- consolidation and maintenance (group 1). Low-dose Ar a-C was given in eighteen cases (32%) (group 2), miscellaneous single agent s were prescribed in seven cases and two patients received only supportive care. Sixteen early deaths (ED) (<1 month) occurred (29%). Distribution of age, WHO-PS, hyperleukocytosis, ED and median survival (MS) (3 months) was equivalent in de novo and sAML. Fifteen CR were achieved including twelve p atients from group 1 (no difference between age <75 versus >75 years) and t hree from group 2. The MS of CR patients was 13 months. Eleven patients sur vived more than one year (de novo: 8). M5 subtype, fever > 38 degrees C, hi gh LDH level, WHO-PS>2, CR non achievement were predictive of reduced survi val. Besides conventional induction, investigational therapies currently re main the best antileukemic modalities. Age per se should not be an exclusio n criteria for treatment. Our data underline the high frequency of sAML in the community. Of note, this common type AML is largely excluded from many trials.