Skip to main content

Advertisement

Log in

Frontline Therapy of AML: Should the Older Patient be Treated Differently?

  • Acute Leukemias (F Ravandi, Section Editor)
  • Published:
Current Hematologic Malignancy Reports Aims and scope Submit manuscript

Abstract

Optimal treatment of acute myeloid leukemia (AML) in older adults (age ≥60 years) remains largely undefined, in part because of the inadequate response to available therapies, the poor prognosis relative to younger adults, the heterogeneity of the population, and the difficulty in determining who is fit for intensive therapy. In contrast to younger patients, there remains uncertainty about disease biology and molecular prognostic factors in elderly AML. While almost all patients may benefit from treatment, with the exception of reduced intensity allogeneic transplantation, there is little evidence that further intensifying therapy will improve outcomes. In fact, recent studies suggest that de-intensified treatment may in fact be superior and allow access to therapy for more patients. Both the disease and the patient must be approached holistically in order to make the best frontline treatment choice together. It is critical that we support well-designed clinical trials to develop more effective frontline therapies, develop more informative biomarkers, and to better understand who is a candidate for curative treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as:• Of importance

  1. Kayser S, Dohner K, Krauter J, et al. The impact of therapy-related acute myeloid leukemia (AML) on outcome in 2853 adult patients with newly diagnosed AML. Blood. 2011;117(7):2137–45.

    Article  CAS  PubMed  Google Scholar 

  2. Grimwade D, Walker H, Harrison G, et al. The predictive value of hierarchical cytogenetic classification in older adults with acute myeloid leukemia (AML): analysis of 1065 patients entered into the United Kingdom Medical Research Council AML11 trial. Blood. 2001;98(5):1312–20.

    Article  CAS  PubMed  Google Scholar 

  3. Appelbaum FR, Gundacker H, Head DR, et al. Age and acute myeloid leukemia. Blood. 2006;107(9):3481–5.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  4. Giles FJ, Borthakur G, Ravandi F, et al. The haematopoietic cell transplantation comorbidity index score is predictive of early death and survival in patients over 60 years of age receiving induction therapy for acute myeloid leukaemia. Br J Haematol. 2007;136(4):624–7.

    Article  PubMed  Google Scholar 

  5. Kantarjian H, Ravandi F, O’Brien S, et al. Intensive chemotherapy does not benefit most older patients (age 70 years or older) with acute myeloid leukemia. Blood. 2010;116(22):4422–9. This paper defines a group of Eldelry AML patients age >70 years who do not benefit from intensive therapy due to high induction mortality.

    Article  CAS  PubMed  Google Scholar 

  6. Siegel R, Ma J, Zou Z, Jemal A. Cancer statistics, 2014. CA Cancer J Clin. 2014;64(1):9–29.

    Article  PubMed  Google Scholar 

  7. Craig BM, Rollison DE, List AF, Cogle CR. Underreporting of myeloid malignancies by United States cancer registries. Cancer Epidemiol Biomarkers Prev. 2012;21(3):474–81.

    Article  PubMed Central  PubMed  Google Scholar 

  8. Linet MS, Devesa SS, Morgan GJ. The leukemias. In: Schottenfeld D, Fraumeni JF, editors. Cancer Epidemiology and Prevention. Thirdth ed. New York, NY: Oxford University Press; 2006.

    Google Scholar 

  9. Ross JA, Blair CK, Cerhan JR, et al. Nonsteroidal anti-inflammatory drug and acetaminophen use and risk of adult myeloid leukemia. Cancer Epidemiol Biomarkers Prev. 2011;20(8):1741–50.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  10. Weiss JR, Baker JA, Baer MR, Menezes RJ, Nowell S, Moysich KB. Opposing effects of aspirin and acetaminophen use on risk of adult acute leukemia. Leuk Res. 2006;30(2):164–9.

    Article  CAS  PubMed  Google Scholar 

  11. Ross JA, Parker E, Blair CK, Cerhan JR, Folsom AR. Body mass index and risk of leukemia in older women. Cancer Epidemiol Biomarkers Prev. 2004;13(11 Pt 1):1810–3.

    PubMed  Google Scholar 

  12. Larsson SC, Wolk A. Overweight and obesity and incidence of leukemia: a meta-analysis of cohort studies. Int J Cancer. 2008;122(6):1418–21.

    Article  CAS  PubMed  Google Scholar 

  13. Blair C, RM, Nguyen P, Cerhan J, Soler J, Ross J. Obesity at different times of life and the risk of AML. Proc 100th Annual Mtg of Am Assoc Cancer Res. 2009;82a.

  14. Moorman AV, Roman E, Cartwright RA, Morgan GJ. Smoking and the risk of acute myeloid leukaemia in cytogenetic subgroups. Br J Cancer. 2002;86(1):60–2.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  15. Lichtman MA. Cigarette smoking, cytogenetic abnormalities, and acute myelogenous leukemia. Leukemia. 2007;21(6):1137–40.

    Article  CAS  PubMed  Google Scholar 

  16. Johnson KJ, Blair CM, Fink JM, et al. Medical conditions and risk of adult myeloid leukemia. Cancer Causes Control. 2012;23(7):1083–9.

    Article  PubMed Central  PubMed  Google Scholar 

  17. Hemminki K, Li X, Sundquist J, Sundquist K. Cancer risks in ulcerative colitis patients. Int J Cancer. 2008;123(6):1417–21.

    Article  CAS  PubMed  Google Scholar 

  18. Polychronakis I, Dounias G, Makropoulos V, Riza E, Linos A. Work-related leukemia: a systematic review. J Occup Med Toxicol. 2013;8(1):14.

    Article  PubMed Central  PubMed  Google Scholar 

  19. Saberi Hosnijeh FCY, Peeters P, Romieu I, Xun W, Riboli E, Raaschou-Nielsen O, et al. Occupation and risk of lymphoid and myeloid leukaemia in the European Prospective Investigation into Cancer and Nutrition (EPIC). Occup Environ Med. 2013;70(7):464–70.

    Article  PubMed  Google Scholar 

  20. Sinner PJ, Cerhan JR, Folsom AR, Ross JA. Positive association of farm or rural residence with acute myeloid leukemia incidence in a cohort of older women. Cancer Epidemiol Biomarkers Prev. 2005;14(10):2446–8.

    Article  PubMed  Google Scholar 

  21. Lang K, Earle CC, Foster T, Dixon D, Van Gool R, Menzin J. Trends in the treatment of acute myeloid leukaemia in the elderly. Drugs Aging. 2005;22(11):943–55.

    Article  PubMed  Google Scholar 

  22. Cornely OA, Maertens J, Winston DJ, et al. Posaconazole vs. fluconazole or itraconazole prophylaxis in patients with neutropenia. N Engl J Med. 2007;356(4):348–59.

    Article  CAS  PubMed  Google Scholar 

  23. McClune BL, Weisdorf DJ, Pedersen TL, et al. Effect of age on outcome of reduced-intensity hematopoietic cell transplantation for older patients with acute myeloid leukemia in first complete remission or with myelodysplastic syndrome. J Clin Oncol. 2010;28(11):1878–87. Demonstrates that increasing age does not predict worse outcome in patients selected for non-myeloablative allogeneic transplantation from an unrelated donor.

  24. Burnett AK, Milligan D, Prentice AG, et al. A comparison of low-dose cytarabine and hydroxyurea with or without all-trans retinoic acid for acute myeloid leukemia and high-risk myelodysplastic syndrome in patients not considered fit for intensive treatment. Cancer. 2007;109(6):1114–24. This was the first study to show a clear survival advantage of low intensity therapy with LDAC for intermediate risk AML over supportive care.

    Article  CAS  PubMed  Google Scholar 

  25. Fenaux P, Mufti GJ, Hellstrom-Lindberg E, et al. Azacitidine prolongs overall survival compared with conventional care regimens in elderly patients with low bone marrow blast count acute myeloid leukemia. J Clin Oncol. 2010;28(4):562–9. Important subgroup analysis of the AZA-001 study showing a survival advantage of azacitidine over conventional care regimens in pateints with 20–30 % blasts.

    Article  CAS  PubMed  Google Scholar 

  26. Kornblith AB, Herndon 2nd JE, Silverman LR, et al. Impact of azacytidine on the quality of life of patients with myelodysplastic syndrome treated in a randomized phase III trial: a Cancer and Leukemia Group B study. J Clin Oncol. 2002;20(10):2441–52.

    Article  CAS  PubMed  Google Scholar 

  27. Gardin C, Chevret S, Pautas C, et al. Superior long-term outcome with idarubicin compared with high-dose daunorubicin in patients with acute myeloid leukemia age 50 years and older. J Clin Oncol. 2013;31(3):321–7.

    Article  CAS  PubMed  Google Scholar 

  28. Tilly H, Castaigne S, Bordessoule D, et al. Low-dose cytarabine versus intensive chemotherapy in the treatment of acute nonlymphocytic leukemia in the elderly. J Clin Oncol. 1990;8(2):272–9.

    CAS  PubMed  Google Scholar 

  29. Lowenberg B, Zittoun R, Kerkhofs H, et al. On the value of intensive remission-induction chemotherapy in elderly patients of 65+ years with acute myeloid leukemia: a randomized phase III study of the European Organization for Research and Treatment of Cancer Leukemia Group. J Clin Oncol. 1989;7(9):1268–74.

    CAS  PubMed  Google Scholar 

  30. Juliusson G, Antunovic P, Derolf A, et al. Age and acute myeloid leukemia: real world data on decision to treat and outcomes from the Swedish Acute Leukemia Registry. Blood. 2009;113(18):4179–87. This population-based registry demonstrated a survival advantage for patients age 70–79 years treated with the intent of achieving a remission (in Sweden).

  31. Walter RB, Kantarjian HM, Huang X, et al. Effect of complete remission and responses less than complete remission on survival in acute myeloid leukemia: a combined Eastern Cooperative Oncology Group, Southwest Oncology Group, and M. D. Anderson Cancer Center Study. J Clin Oncol. 2010;28(10):1766–71.

    Article  PubMed Central  PubMed  Google Scholar 

  32. Denzlinger C, Bowen D, Benz D, Gelly K, Brugger W, Kanz L. Low-dose melphalan induces favourable responses in elderly patients with high-risk myelodysplastic syndromes or secondary acute myeloid leukaemia. Br J Haematol. 2000;108(1):93–5.

    Article  CAS  PubMed  Google Scholar 

  33. Lowenberg B, Suciu S, Archimbaud E, et al. Mitoxantrone versus daunorubicin in induction-consolidation chemotherapy–the value of low-dose cytarabine for maintenance of remission, and an assessment of prognostic factors in acute myeloid leukemia in the elderly: final report. European Organization for the Research and Treatment of Cancer and the Dutch-Belgian Hemato-Oncology Cooperative Hovon Group. J Clin Oncol. 1998;16(3):872–81.

    CAS  PubMed  Google Scholar 

  34. Wheatley K, Brookes CL, Howman AJ, et al. Prognostic factor analysis of the survival of elderly patients with AML in the MRC AML11 and LRF AML14 trials. Br J Haematol. 2009;145(5):598–605.

    Article  PubMed  Google Scholar 

  35. Krug U, Rollig C, Koschmieder A, et al. Complete remission and early death after intensive chemotherapy in patients aged 60 years or older with acute myeloid leukaemia: a web-based application for prediction of outcomes. Lancet. 2010;376(9757):2000–8.

    Article  CAS  PubMed  Google Scholar 

  36. Klepin HD, Geiger AM, Tooze JA, et al. Geriatric assessment predicts survival for older adults receiving induction chemotherapy for acute myelogenous leukemia. Blood. 2013;121(21):4287–94.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  37. Sherman AE, Motyckova G, Fega KR, et al. Geriatric assessment in older patients with acute myeloid leukemia: a retrospective study of associated treatment and outcomes. Leuk Res. 2013;37(9):998–1003.

    Article  PubMed  Google Scholar 

  38. Bertoli S, Berard E, Huguet F, et al. Time from diagnosis to intensive chemotherapy initiation does not adversely impact the outcome of patients with acute myeloid leukemia. Blood. 2013;121(14):2618–26.

    Article  CAS  PubMed  Google Scholar 

  39. Patel JP, Gonen M, Figueroa ME, et al. Prognostic relevance of integrated genetic profiling in acute myeloid leukemia. N Engl J Med. 2012;366(12):1079–89. ECOG study showed the prevalance and clinical impact of occult mutations io younger AML patients receiving intensive treatment.

  40. Genomic and epigenomic landscapes of adult de novo acute myeloid leukemia. N Engl J Med. 2013;368(22):2059–74. Landmark paper from The Cancer Genome Atlas establishing incidence of baseline genetic lesions in AML. Its direct relevance to the large populations of Elderly AML patients remains a question.

  41. Stirewalt DL, Kopecky KJ, Meshinchi S, et al. FLT3, RAS, and TP53 mutations in elderly patients with acute myeloid leukemia. Blood. 2001;97(11):3589–95.

    Article  CAS  PubMed  Google Scholar 

  42. Schlenk RF, Dohner K, Kneba M, et al. Gene mutations and response to treatment with all-trans retinoic acid in elderly patients with acute myeloid leukemia. Results from the AMLSG Trial AML HD98B. Haematologica. 2009;94(1):54–60.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  43. Rollig C, Bornhauser M, Thiede C, et al. Long-term prognosis of acute myeloid leukemia according to the new genetic risk classification of the European LeukemiaNet recommendations: evaluation of the proposed reporting system. J Clin Oncol. 2011;29(20):2758–65.

    Article  PubMed  Google Scholar 

  44. Ferrara F, Criscuolo C, Riccardi C, et al. FLT3 mutations have no prognostic impact in elderly patients with acute myeloid leukemia and normal karyotype. Am J Hematol. 2009;84(8):532–5.

    Article  CAS  PubMed  Google Scholar 

  45. Su L, Li X, Gao SJ, et al. Cytogenetic and genetic mutation features of de novo acute myeloid leukemia in elderly chinese patients. Asian Pac J Cancer Prev. 2014;15(2):895–8.

    PubMed  Google Scholar 

  46. Whitman SP, Maharry K, Radmacher MD, et al. FLT3 internal tandem duplication associates with adverse outcome and gene- and microRNA-expression signatures in patients 60 years of age or older with primary cytogenetically normal acute myeloid leukemia: a Cancer and Leukemia Group B study. Blood. 2010;116(18):3622–6.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  47. Becker H, Marcucci G, Maharry K, et al. Favorable prognostic impact of NPM1 mutations in older patients with cytogenetically normal de novo acute myeloid leukemia and associated gene- and microRNA-expression signatures: a Cancer and Leukemia Group B study. J Clin Oncol. 2010;28(4):596–604.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  48. Nazha A, Bueso-Ramos C, Estey E, et al. The addition of all-trans retinoic acid to chemotherapy may not improve the outcome of patient with NPM1 mutated acute myeloid leukemia. Front Oncol. 2013;3:218.

    Article  PubMed Central  PubMed  Google Scholar 

  49. Marcucci G, Metzeler KH, Schwind S, et al. Age-related prognostic impact of different types of DNMT3A mutations in adults with primary cytogenetically normal acute myeloid leukemia. J Clin Oncol. 2012;30(7):742–50.

    Article  PubMed Central  PubMed  Google Scholar 

  50. Marcucci G, Yan P, Maharry K, et al. Epigenetics meets genetics in acute myeloid leukemia: clinical impact of a novel seven-gene score. J Clin Oncol. 2014;32(6):548–56.

    Article  PubMed  Google Scholar 

  51. Rowe JM, Neuberg D, Friedenberg W, et al. A phase 3 study of three induction regimens and of priming with GM-CSF in older adults with acute myeloid leukemia: a trial by the Eastern Cooperative Oncology Group. Blood. 2004;103(2):479–85.

    Article  CAS  PubMed  Google Scholar 

  52. Goldstone AH, Burnett AK, Wheatley K, Smith AG, Hutchinson RM, Clark RE. Attempts to improve treatment outcomes in acute myeloid leukemia (AML) in older patients: the results of the United Kingdom Medical Research Council AML11 trial. Blood. 2001;98(5):1302–11.

    Article  CAS  PubMed  Google Scholar 

  53. Anderson JE, Kopecky KJ, Willman CL, et al. Outcome after induction chemotherapy for older patients with acute myeloid leukemia is not improved with mitoxantrone and etoposide compared to cytarabine and daunorubicin: a Southwest Oncology Group study. Blood. 2002;100(12):3869–76.

    Article  CAS  PubMed  Google Scholar 

  54. Fernandez HF, Sun Z, Yao X, et al. Anthracycline dose intensification in acute myeloid leukemia. N Engl J Med. 2009;361(13):1249–59.

    Article  CAS  PubMed  Google Scholar 

  55. Lowenberg B, Ossenkoppele GJ, van Putten W, et al. High-dose daunorubicin in older patients with acute myeloid leukemia. N Engl J Med. 2009;361(13):1235–48.

    Article  PubMed  Google Scholar 

  56. Attar EC, Johnson JL, Amrein PC, et al. Bortezomib added to daunorubicin and cytarabine during induction therapy and to intermediate-dose cytarabine for consolidation in patients with previously untreated acute myeloid leukemia age 60 to 75 years: CALGB (Alliance) study 10502. J Clin Oncol. 2013;31(7):923–9.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  57. Kim I, Koh Y, Yoon SS, et al. Fludarabine, cytarabine, and attenuated-dose idarubicin (m-FLAI) combination therapy for elderly acute myeloid leukemia patients. Am J Hematol. 2013;88(1):10–5.

    Article  CAS  PubMed  Google Scholar 

  58. Kantarjian H, O’Brien S, Cortes J, et al. Results of intensive chemotherapy in 998 patients age 65 years or older with acute myeloid leukemia or high-risk myelodysplastic syndrome: predictive prognostic models for outcome. Cancer. 2006;106(5):1090–8.

    Article  PubMed  Google Scholar 

  59. Farag SS, Archer KJ, Mrozek K, et al. Pretreatment cytogenetics add to other prognostic factors predicting complete remission and long-term outcome in patients 60 years of age or older with acute myeloid leukemia: results from Cancer and Leukemia Group B 8461. Blood. 2006;108(1):63–73.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  60. Burnett AK, Russell NH, Kell J, et al. European development of clofarabine as treatment for older patients with acute myeloid leukemia considered unsuitable for intensive chemotherapy. J Clin Oncol. 2010;28(14):2389–95.

    Article  CAS  PubMed  Google Scholar 

  61. Kantarjian HM, Erba HP, Claxton D, et al. Phase II study of clofarabine monotherapy in previously untreated older adults with acute myeloid leukemia and unfavorable prognostic factors. J Clin Oncol. 2010;28(4):549–55.

    Article  CAS  PubMed  Google Scholar 

  62. Burnett AK, Russell NH, Hills RK, et al. Addition of gemtuzumab ozogamicin to induction chemotherapy improves survival in older patients with acute myeloid leukemia. J Clin Oncol. 2012;30(32):3924–31.

    Article  CAS  PubMed  Google Scholar 

  63. Castaigne S, Pautas C, Terre C, et al. Effect of gemtuzumab ozogamicin on survival of adult patients with de-novo acute myeloid leukaemia (ALFA-0701): a randomised, open-label, phase 3 study. Lancet. 2012;379(9825):1508–16.

    Article  CAS  PubMed  Google Scholar 

  64. Amadori S, Suciu S, Stasi R, et al. Sequential combination of gemtuzumab ozogamicin and standard chemotherapy in older patients with newly diagnosed acute myeloid leukemia: results of a randomized phase III trial by the EORTC and GIMEMA consortium (AML-17). J Clin Oncol. 2013;31(35):4424–30.

    Article  CAS  PubMed  Google Scholar 

  65. Thépot S, Itzykson R, Seegers V, et al. Azacitidine in untreated acute myeloid leukemia: a report on 149 patients. Am J Hematol. 2014;89(4):410–6.

  66. van der Helm LH, Veeger NJ, Kooy M, et al. Azacitidine results in comparable outcome in newly diagnosed AML patients with more or less than 30 % bone marrow blasts. Leuk Res. 2013;37(8):877–82.

    Article  PubMed  Google Scholar 

  67. Blum W, Garzon R, Klisovic RB, et al. Clinical response and miR-29b predictive significance in older AML patients treated with a 10-day schedule of decitabine. Proc Natl Acad Sci U S A. 2010;107(16):7473–8.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  68. Cashen AF, Schiller GJ, O’Donnell MR, DiPersio JF. Multicenter, phase II study of decitabine for the first-line treatment of older patients with acute myeloid leukemia. J Clin Oncol. 2010;28(4):556–61.

    Article  CAS  PubMed  Google Scholar 

  69. Kantarjian HM, Thomas XG, Dmoszynska A, et al. Multicenter, randomized, open-label, phase III trial of decitabine versus patient choice, with physician advice, of either supportive care or low-dose cytarabine for the treatment of older patients with newly diagnosed acute myeloid leukemia. J Clin Oncol. 2012;30(21):2670–7.

    Article  CAS  PubMed  Google Scholar 

  70. Craddock C, Quek L, Goardon N, et al. Azacitidine fails to eradicate leukemic stem/progenitor cell populations in patients with acute myeloid leukemia and myelodysplasia. Leukemia. 2013;27(5):1028–36.

    Article  CAS  PubMed  Google Scholar 

  71. Burnett AK, Hills RK, Hunter AE, et al. The addition of gemtuzumab ozogamicin to low-dose Ara-C improves remission rate but does not significantly prolong survival in older patients with acute myeloid leukaemia: results from the LRF AML14 and NCRI AML16 pick-a-winner comparison. Leukemia. 2013;27(1):75–81.

    Article  CAS  PubMed  Google Scholar 

  72. Burnett AK, Russell NH, Culligan D, et al. The addition of the farnesyl transferase inhibitor, tipifarnib, to low dose cytarabine does not improve outcome for older patients with AML. Br J Haematol. 2012;158(4):519–22.

    Article  CAS  PubMed  Google Scholar 

  73. Burnett AK, Hills RK, Hunter A, et al. The addition of arsenic trioxide to low-dose Ara-C in older patients with AML does not improve outcome. Leukemia. 2011;25(7):1122–7.

    Article  CAS  PubMed  Google Scholar 

  74. Macdonald DA, Assouline SE, Brandwein J, et al. A phase I/II study of sorafenib in combination with low dose cytarabine in elderly patients with acute myeloid leukemia or high-risk myelodysplastic syndrome from the National Cancer Institute of Canada Clinical Trials Group: trial IND.186. Leuk Lymphoma. 2013;54(4):760–6.

    Article  CAS  PubMed  Google Scholar 

  75. Ravandi F, Alattar ML, Grunwald MR, et al. Phase 2 study of azacytidine plus sorafenib in patients with acute myeloid leukemia and FLT-3 internal tandem duplication mutation. Blood. 2013;121(23):4655–62.

    Article  CAS  PubMed  Google Scholar 

  76. Cortes JE, Kantarjian H, Foran JM, et al. Phase I study of quizartinib administered daily to patients with relapsed or refractory acute myeloid leukemia irrespective of FMS-like tyrosine kinase 3-internal tandem duplication status. J Clin Oncol. 2013;31(29):3681–7.

    Article  CAS  PubMed  Google Scholar 

  77. Quintas-Cardama A, Ravandi F, Liu-Dumlao T, et al. Epigenetic therapy is associated with similar survival compared with intensive chemotherapy in older patients with newly diagnosed acute myeloid leukemia. Blood. 2012;120(24):4840–5.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  78. Burnett AK, Russell NH, Hunter AE, et al. Clofarabine doubles the response rate in older patients with acute myeloid leukemia but does not improve survival. Blood. 2013;122(8):1384–94. Despite increasing the CR rate, clofarabine did not increase survival compared with LDAC, suggesting that CR is not an adequate surrogate endopint, and that we have still not optimally defined appropriate patients for lower versus higher intensity traement.

  79. Hahn T, McCarthy Jr PL, Hassebroek A, et al. Significant improvement in survival after allogeneic hematopoietic cell transplantation during a period of significantly increased use, older recipient age, and use of unrelated donors. J Clin Oncol. 2013;31(19):2437–49.

    Article  PubMed  Google Scholar 

  80. Mawad R, Gooley TA, Sandhu V, et al. Frequency of allogeneic hematopoietic cell transplantation among patients with high- or intermediate-risk acute myeloid leukemia in first complete remission. J Clin Oncol. 2013;31(31):3883–8.

    Article  PubMed  Google Scholar 

  81. Devine SM, Owza K, Blum W, et al. A Phase II Study of Allogeneic Transplantation for Older Patients with AML in First Complete Remission Using a Reduced Intensity Conditioning Regimen: Results From CALGB 100103/BMT CTN 0502. Blood (Proc ASH). 2012;120:230a.

    Google Scholar 

Download references

Compliance with Ethics Guidelines

Conflict of Interest

Dr. James M. Foran received a grant from Astellas (Quizartinib phase I trial).

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to James M. Foran.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Foran, J.M. Frontline Therapy of AML: Should the Older Patient be Treated Differently?. Curr Hematol Malig Rep 9, 100–108 (2014). https://doi.org/10.1007/s11899-014-0211-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11899-014-0211-8

Keywords

Navigation