Acute Myeloid Leukemia in Patients Older than 60 Year

Abstract

The determinants of treatment success and failure remain partly understood. A combination of patient-related and specific disease-related factors are more common among this aging population and correlate markedly with treatment failure (i.e., primary resistance and relapse after induction therapy). They include comorbid conditions, performance status, decreased drug clearance and prolonged exposure to chemotherapeutics resulting from pharmacokinetic and pharmacodynamic changes, less tolerability to infections due to decreased immune competence of elderly patients, psychosocial factors (cognitive decline, social isolation, and, often, lack of caretakers), multidrug resistant abilities of the leukemia cells to expel the chemotherapeutics, antecedent hematologic disorders [3] (previous MDS, chronic myelomonocytic leukemia, myeloproliferative neoplasm), prior exposure to cytotoxic therapy for other disorders [4] and higher frequencies of adverse cytogenetics and unfavorable molecular aberrations [3].