Therapy of acute myeloid leukemia in elderly patients

Incidence and mortality rates of acute myeloid leukemia (AML) increase expo nentially with advancing age. AML diagnosed in elderly patients differs fro m that diagnosed in younger patients. But not only disease-specific differe nces are important. Treating elderly patients with AML age-associated diffe rences in the patients general presentation, such as physiological changes in organ function, decreased ability to react to stress, dependence in acti vities of daily living, existence of other morbidities (co-morbity), the ne ed to take drugs for those diseases and the reduced life expectancy can for ce alterations in the disease management. Clinical trials for the treatment of AML have been excluding elderly patien ts for years. Even trials accepting elderly patients with AML did select th e group of otherwise healthy elderly patients for participation in the tria l. Thus the data for AML managment in elderly patients do not reflect the w hole group of elderly patients with AML. If the patient is treated with cur ative intention, therapy of choice is the so-called 3+7 protocol for induct ion of complete remission, followed by a consolidation therapy and in some cases by maintenance therapy. In some situations, especially in very old pa tients, a palliative intention to treatment is favored. There are no genera lly accepted criteria to measure treatment benefit in this setting nor esta blished chemotherapy protocols for this situation. Furter trials for elderl y patients with AML have to offer treatment options for the whole group of patients and have to determine what treatment approach is the best for whic h individual patient.