Recent improvements in outcome for elderly patients with de novo acute myeloblastic leukemia

A retrospective analysis was performed on 263 consecutive patients aged ove r 60 with de novo acute myeloid leukemia (AML) diagnosed in a single instit ution between 1979 and 1998. Eighty-nine patients (33%) received only palli ative treatment, while 174 patients (67%) were treated with different inten sive chemotherapy regimens. The 5- and 10-year overall survival (OS) for th e whole series was 7.7 +/-1.2 and 4.3 +/-1.6%, respectively. For patients r eceiving chemotherapy, OS was 10.5 +/-2.5 and 7 +/-2.6%, while for those pa tients receiving supportive treatment it was 1.1 +/-1.1 and 0%, respectivel y (P = 0.002). Within the group of patients receiving chemotherapy, the com plete remission (CR) rate was 46%; treatment failure rate was 54% (36% due to treatment-related mortality and 18% due to resistant disease). Variables influencing CR rate were FAB subtype, CD7 positivity, chemotherapy regimen , creatinine, level, hepatomegaly, and period of diagnosis. Median disease- free survival (DFS) duration was 8.4 months with a probability of being dis ease-free at 10 years of 10 +/-5%. There were no significant differences in DFS according to age. According to the period of diagnosis (1979-1986 vs. 1987-1998), improvements in the CR rate (27 vs. 56%, P = 0.0002), and OS (1 0.9 vs. 15.7 months, P = 0.0007) were observed. This large single-center st udy of unselected de novo AML elderly patients substantiates the progressiv e improvement achieved in the management of elderly patients with AML, prob ably due to an improvement in supportive care and the administration of con ventional induction chemotherapy. (C) 2001 Elsevier Science Ltd. All rights reserved.