Vnitr Lek 2010, 56(1):37-43

Patients older than 80 years with de novo acute myeloid leukemias without erythroblastic and/or megakaryocytic dysplasia achieve complete remission and longer survival after classical chemotherapy 3 + 7

P. Lemež^1,4,*, J. Gáliková¹, K. Michalová², D. Dvořáková³, A. MacWhannell⁴, Z. Zemanová², J. Stejskal³

¹ Hematologicko-transfuzní oddělení Nemocnice Jihlava, přednostka prim. MUDr. Jiřina Gáliková

² Centrum nádorové cytogenetiky Ústavu klinické biochemie 1. lékařské fakulty UK a VFN Praha, vedoucí prof. Ing. Kyra Michalová, DrSc.

³ Oddělení klinické a radiační onkologie Krajské nemocnice Pardubice, přednosta doc. MUDr. Jaroslav Vaňásek, CSc.

⁴ Department of Hematology, New Cross Hospital, Wolverhampton, England, vedoucí M.D. S. Basu, FRCPath.

Chemotherapy in most patients with AML over 80 years of age is not recommended because their median survival is about 1 month. The aim of our study was to identify patients in this age group who might achieve complete remission with standard dose chemotherapy. We report 9 consecutive patients with de novo AML diagnosed and treated in 1992-2008. All bone marrow samples were hypercellular, classified as FAB types M2 in 2 cases, M4 in 6, and M5 in one case. Three patients opted for supportive or palliative therapy and survived 1-4 months. Six patients received standard dose chemotherapy. Two patients with a normal karyotype had resistant AML and survived 1.0 and 2.7 months; one patient with a complex karyotype died of septic shock on the 10th day of therapy. All these three patients exhibited erythroblastic and/or megakaryocytic dysplasia (EMD) at presentation (two in more than 26% erythroblasts, all three in a half or more of megakaryocytes). Three remaining patients with AML M4, a normal karyotype but without EMD, achieved complete remission in spite of comorbidities and a poor performance status. Two of them survived 18.6 and 28 months on maintenance therapy, the third 16.5 months without it. Very elderly AML patients without EMD appear to represent a favorable prognostic biological category (single-lineage AML) that show a good response to standard dose chemotherapy.

Keywords: acute myeloid leukemias; patients aged over 80 years; single-lineage AMLs; multi-lineage AMLs; normal karyotype; standard dose chemotherapy; dexrazoxane

Received: May 19, 2009; Accepted: October 23, 2009; Published: January 1, 2010  Show citation