Skip to main content

Acute Myeloid Leukemia in Older Adults

  • Living reference work entry
  • First Online:
Geriatric Oncology

Abstract

Acute myeloid leukemia (AML) is a disease of older adults, and approximately 58% are diagnosed in those aged ≥65 years. Outcomes in older adults with AML are poor due to a combination of factors including disease biology, under-referral, undertreatment, and poor treatment tolerability. For selected older patients with AML, treatment is associated with improved survival. The optimal treatment for older patients with AML is unclear. While intensive induction chemotherapy has been used for the last few decades, it has been associated with high treatment-related morbidity and mortality. In the last decade, many advances in the treatment of AML have been made, including the use of targeted agents and novel combinations of lower-intensity treatments, the latter of which may have better tolerability and similar or better efficacy compared to intensive chemotherapy. Nonetheless, to help personalize therapies for older adults with AML, it is important to assess individual fitness through the use of a geriatric assessment. Improving outcomes of older adults with AML will rely on both development of novel therapies and targeting therapy to their physiologic fitness and disease biology.

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

Access this chapter

Institutional subscriptions

References

  • Aaldriks AA, Giltay EJ, le Cessie S, et al. Prognostic value of geriatric assessment in older patients with advanced breast cancer receiving chemotherapy. Breast. 2013;22(5):753–60.

    Article  CAS  PubMed  Google Scholar 

  • Abel GA, Klepin HD. Frailty and the management of hematologic malignancies. Blood. 2018;131(5):515–524.

    Google Scholar 

  • Alibhai SM, Leach M, Kermalli H, et al. The impact of acute myeloid leukemia and its treatment on quality of life and functional status in older adults. Crit Rev Oncol Hematol. 2007;64(1):19–30.

    Article  PubMed  Google Scholar 

  • Alibhai SM, Leach M, Minden MD, Brandwein J. Outcomes and quality of care in acute myeloid leukemia over 40 years. Cancer. 2009a;115(13):2903–11.

    Article  PubMed  Google Scholar 

  • Alibhai SM, Leach M, Gupta V, et al. Quality of life beyond 6 months after diagnosis in older adults with acute myeloid leukemia. Crit RevOncolHematol. 2009b;69(2):168–74.

    Google Scholar 

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

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Baer MR, George SL, Dodge RK, et al. Phase 3 study of the multidrug resistance modulator PSC-833 in previously untreated patients 60 years of age and older with acute myeloid leukemia: Cancer and leukemia group B study 9720. Blood. 2002;100(4):1224–32.

    CAS  PubMed  Google Scholar 

  • 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. JClinOncol. 2010;28(4):596–604.

    Article  CAS  Google Scholar 

  • Buckley SA, Kirtane K, Walter RB, Lee SJ, Lyman GH. Patient-reported outcomes in acute myeloid leukemia: where are we now? Blood Rev. 2018;32(1):81–7.

    Article  PubMed  Google Scholar 

  • 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.

    Article  CAS  PubMed  Google Scholar 

  • 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 

  • Burnett AK, Russell NH, Hills RK, et al. A randomized comparison of daunorubicin 90 mg/m2 vs 60 mg/m2 in AML induction: results from the UK NCRI AML17 trial in 1206 patients. Blood. 2015;125(25):3878–85.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Burnett AK, Russell NH, Hills RK, et al. A comparison of clofarabine with ara-C, each in combination with daunorubicin as induction treatment in older patients with acute myeloid leukaemia. Leukemia. 2017;31(2):310–7.

    Article  CAS  PubMed  Google Scholar 

  • Cassileth PA, Harrington DP, Hines JD, et al. Maintenance chemotherapy prolongs remission duration in adult acute nonlymphocytic leukemia. J Clin Oncol. 1988;6(4):583–7.

    Article  CAS  PubMed  Google Scholar 

  • 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 

  • Chen Y, Kantarjian H, Wang H, Cortes J, Ravandi F. Acute promyelocytic leukemia: a population-based study on incidence and survival in the United States, 1975-2008. Cancer. 2012;118(23):5811–8.

    Article  PubMed  Google Scholar 

  • Cortes JE, Heidel FH, Hellmann A, et al. Randomized comparison of low dose cytarabine with or without glasdegib in patients with newly diagnosed acute myeloid leukemia or high-risk myelodysplastic syndrome. Leukemia. 2019;33(2):379–389.

    Google Scholar 

  • Cripe LD, Uno H, Paietta EM, et al. Zosuquidar, a novel modulator of P-glycoprotein, does not improve the outcome of older patients with newly diagnosed acute myeloid leukemia: a randomized, placebo-controlled trial of the eastern cooperative oncology group 3999. Blood. 2010;116(20):4077–85.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • de The H, Chen Z. Acute promyelocytic leukaemia: novel insights into the mechanisms of cure. Nat Rev Cancer. 2010;10(11):775–83.

    Article  CAS  PubMed  Google Scholar 

  • Deschler B, Ihorst G, Platzbecker U, et al. Parameters detected by geriatric and quality of life assessment in 195 older patients with myelodysplastic syndromes and acute myeloid leukemia are highly predictive for outcome. Haematologica. 2013;98(2):208–16.

    Article  PubMed  PubMed Central  Google Scholar 

  • Devine SM, Owzar K, Blum W, et al. Phase II study of allogeneic transplantation for older patients with acute myeloid leukemia in first complete remission using a reduced-intensity conditioning regimen: results from Cancer and leukemia group B 100103 (Alliance for clinical trials in oncology)/blood and marrow transplant clinical trial network 0502. J Clin Oncol. 2015;33(35):4167–75.

    Article  PubMed  PubMed Central  Google Scholar 

  • Dillman RO, Davis RB, Green MR, et al. A comparative study of two different doses of cytarabine for acute myeloid leukemia: a phase III trial of Cancer and leukemia group B. Blood. 1991;78(10):2520–6.

    CAS  PubMed  Google Scholar 

  • DiNardo CD, Pratz K, Pullarkat V, et al. Venetoclax combined with decitabine or azacitidine in treatment-naive, elderly patients with acute myeloid leukemia. Blood. 2019;133(1):7–17.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Dinmohamed AG, Visser O, van Norden Y, et al. Treatment, trial participation and survival in adult acute myeloid leukemia: a population-based study in the Netherlands, 1989-2012. Leukemia. 2016;30(1):24–31.

    Article  CAS  PubMed  Google Scholar 

  • Döhner H, Estey E, Grimwade D, et al. Diagnosis and management of AML in adults: 2017 ELN recommendations from an international expert panel. Blood. 2017;129(4):424–47.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Dombret H, Seymour JF, Butrym A, et al. International phase 3 study of azacitidine vs conventional care regimens in older patients with newly diagnosed AML with >30% blasts. Blood. 2015;126(3):291–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Eisfeld AK, Kohlschmidt J, Mrozek K, et al. Mutation patterns identify adult patients with de novo acute myeloid leukemia aged 60 years or older who respond favorably to standard chemotherapy: an analysis of Alliance studies. Leukemia. 2018;32(6):1338–48.

    Article  PubMed  PubMed Central  Google Scholar 

  • El-Jawahri AR, Abel GA, Steensma DP, et al. Health care utilization and end-of-life care for older patients with acute myeloid leukemia. Cancer. 2015;121:2840–8.

    Article  PubMed  Google Scholar 

  • Etienne A, Esterni B, Charbonnier A, et al. Comorbidity is an independent predictor of complete remission in elderly patients receiving induction chemotherapy for acute myeloid leukemia. Cancer. 2007;109(7):1376–83.

    Article  PubMed  Google Scholar 

  • European Medicines Agency. Reflection paper on physical frailty: instruments for baseline characterisation of older populations in clinical trials. 2018. http://www.ema.europa.eu/docs/en_GB/document_library/Scientific_guideline/2018/02/WC500244285.pdf. Accessed 28 Mar 2018.

  • Extermann M, Boler I, Reich RR, et al. Predicting the risk of chemotherapy toxicity in older patients: The chemotherapy risk assessment scale for high-age patients (CRASH) score. Cancer. 2011;118(31):3377–86.

    PubMed  Google Scholar 

  • Faderl S, Verstovsek S, Cortes J, et al. Clofarabine and cytarabine combination as induction therapy for acute myeloid leukemia (AML) in patients 50 years of age or older. Blood. 2006;108(1):45–51.

    Article  CAS  PubMed  Google Scholar 

  • 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  PubMed Central  Google Scholar 

  • 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.

    Article  CAS  PubMed  Google Scholar 

  • Foran JM, Sun Z, Claxton DF, et al. North American Leukemia, Intergroup phase III randomized trial of single agent Clofarabine as induction and post-remission therapy, and Decitabine as maintenance therapy in newly-diagnosed acute myeloid leukemia in older adults (age ≥60 years): a trial of the ECOG-ACRIN Cancer Research Group (E2906). Blood. 2015;126(23):217.

    Google Scholar 

  • Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56(3):M146–56.

    Article  CAS  PubMed  Google Scholar 

  • Frohling S, Schlenk RF, Kayser S, et al. Cytogenetics and age are major determinants of outcome in intensively treated acute myeloid leukemia patients older than 60 years: results from AMLSG trial AML HD98-B. Blood. 2006;108(10):3280–8.

    Article  CAS  PubMed  Google Scholar 

  • Gardin C, Dombret H. Hypomethylating agents as a therapy for AML. Curr Hematol Malig Rep. 2017;12(1):1–10.

    Article  PubMed  Google Scholar 

  • Gardin C, Turlure P, Fagot T, et al. Postremission treatment of elderly patients with acute myeloid leukemia in first complete remission after intensive induction chemotherapy: results of the multicenter randomized Acute Leukemia French Association (ALFA) 9803 trial. Blood. 2007;109(12):5129–35.

    Article  CAS  PubMed  Google Scholar 

  • 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. BrJHaematol. 2007;136(4):624–7.

    Google Scholar 

  • Godwin JE, Smith SE. Acute myeloid leukemia in the older patient. Crit RevOncolHematol. 2003;48(Suppl):S17–26.

    Google Scholar 

  • Godwin JE, Kopecky KJ, Head DR, et al. A double-blind placebo-controlled trial of granulocyte colony-stimulating factor in elderly patients with previously untreated acute myeloid leukemia: a southwest oncology group study (9031). Blood. 1998;91(10):3607–15.

    CAS  PubMed  Google Scholar 

  • 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 

  • Granfeldt Ostgard LS, Medeiros BC, Sengelov H, et al. Epidemiology and clinical significance of secondary and therapy-related acute myeloid leukemia: a National Population-Based Cohort Study. J Clin Oncol. 2015;33(31):3641–9.

    Article  PubMed  Google Scholar 

  • 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 

  • Grishina O, Schmoor C, Dohner K, et al. DECIDER: prospective randomized multicenter phase II trial of low-dose decitabine (DAC) administered alone or in combination with the histone deacetylase inhibitor valproic acid (VPA) and all-trans retinoic acid (ATRA) in patients >60 years with acute myeloid leukemia who are ineligible for induction chemotherapy. BMC Cancer. 2015;15:430.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Gupta V, Chun K, Yi QL, et al. Disease biology rather than age is the most important determinant of survival of patients > or = 60 years with acute myeloid leukemia treated with uniform intensive therapy. Cancer. 2005;103(10):2082–90.

    Article  PubMed  Google Scholar 

  • Guralnik JM, Simonsick EM, Ferrucci L, et al. A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol. 1994;49(2):M85–94.

    Article  CAS  PubMed  Google Scholar 

  • Guralnik JM, Ferrucci L, Simonsick EM, Salive ME, Wallace RB. Lower-extremity function in persons over the age of 70 years as a predictor of subsequent disability. N Engl J Med. 1995;332(9):556–61.

    Article  CAS  PubMed  Google Scholar 

  • Guralnik JM, Ferrucci L, Pieper CF, et al. Lower extremity function and subsequent disability: consistency across studies, predictive models, and value of gait speed alone compared with the short physical performance battery. J Gerontol A Biol Sci Med Sci. 2000;55(4):M221–31.

    Article  CAS  PubMed  Google Scholar 

  • Hamaker ME, Prins MC, Stauder R. The relevance of a geriatric assessment for elderly patients with a haematological malignancy--a systematic review. Leuk Res. 2014a;38(3):275–83.

    Article  CAS  PubMed  Google Scholar 

  • Hamaker ME, Stauder R, van Munster BC. On-going clinical trials for elderly patients with a hematological malignancy: are we addressing the right end points? Annals of oncology: official journal of the European Society for Medical Oncology/ESMO. 2014b;25(3):675–81.

    Article  CAS  Google Scholar 

  • Hamaker ME, Wildes TM, Rostoft S. Time to stop saying geriatric assessment is too time consuming. J Clin Oncol. 2017;35(25):2871–4.

    Article  PubMed  Google Scholar 

  • Hurria A, Togawa K, Mohile SG, et al. Predicting chemotherapy toxicity in older adults with cancer: a prospective multicenter study. J Clin Oncol. 2011;29(25):3457–65.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Hurria A, Levit LA, Dale W, et al. Improving the evidence base for treating older adults with Cancer: American Society of Clinical Oncology statement. J Clin Oncol. 2015;33(32):3826–33.

    Article  PubMed  Google Scholar 

  • Juliusson G. Most 70- to 79-year-old patients with acute myeloid leukemia do benefit from intensive treatment. Blood. 2011;117(12):3473–4.

    Article  CAS  PubMed  Google Scholar 

  • 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.

    Article  CAS  PubMed  Google Scholar 

  • Juliusson G, Lazarevic V, Horstedt AS, Hagberg O, Hoglund M. Swedish acute leukemia registry G. Acute myeloid leukemia in the real world: why population-based registries are needed. Blood. 2012;119(17):3890–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • 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 

  • 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.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • 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  PubMed Central  Google Scholar 

  • Kayastha N, Wolf SP, Locke SC, Samsa GP, El-Jawahri A, LeBlanc TW. The impact of remission status on patients’ experiences with acute myeloid leukemia (AML): an exploratory analysis of longitudinal patient-reported outcomes data. Support Care Cancer. 2018;26(5):1437–1445.

    Google Scholar 

  • Klepin HD, Geiger AM, Tooze JA, et al. The feasibility of inpatient geriatric assessment for older adults receiving induction chemotherapy for acute myelogenous leukemia. JAmGeriatrSoc. 2011;59(10):1837–46.

    Google Scholar 

  • 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  PubMed Central  Google Scholar 

  • Klepin HD, Tooze JA, Pardee TS, et al. Effect of intensive chemotherapy on physical, cognitive, and emotional health of older adults with acute myeloid leukemia. J Am Geriatr Soc. 2016;64(10):1988–95.

    Article  PubMed  PubMed Central  Google Scholar 

  • 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 

  • Lancet JE, Uy GL, Cortes JE, et al. CPX-351 (cytarabine and daunorubicin) liposome for injection versus conventional Cytarabine plus Daunorubicin in older patients with newly diagnosed secondary acute myeloid leukemia. J Clin Oncol. 2018:Jco2017776112.

    Google Scholar 

  • Lehmann S, Ravn A, Carlsson L, et al. Continuing high early death rate in acute promyelocytic leukemia: a population-based report from the Swedish adult acute leukemia registry. Leukemia. 2011;25(7):1128–34.

    Article  CAS  PubMed  Google Scholar 

  • Leith CP, Kopecky KJ, Godwin J, et al. Acute myeloid leukemia in the elderly: assessment of multidrug resistance (MDR1) and cytogenetics distinguishes biologic subgroups with remarkably distinct responses to standard chemotherapy. A southwest oncology group study. Blood. 1997;89(9):3323–9.

    CAS  PubMed  Google Scholar 

  • Levit LA, Singh H, Klepin HD, Hurria A. Expanding the evidence base in geriatric oncology: action items from an FDA-ASCO workshop. J Natl Cancer Inst. 2018;110(11):1163–70.

    Article  PubMed  Google Scholar 

  • Lo-Coco F, Avvisati G, Vignetti M, et al. Retinoic acid and arsenic trioxide for acute promyelocytic leukemia. N Engl J Med. 2013;369(2):111–21.

    Article  CAS  PubMed  Google Scholar 

  • Loh KP, Klepin H. Incorporating physical function and cognition into mortality risk assessment for acute myeloid leukemia. JAMA Oncol. 2018a;4(7):1014.

    Article  PubMed  Google Scholar 

  • Loh KP, Klepin HD. Geriatric assessment in older patients with acute myeloid leukemia. Cancers. 2018b;10(7)

    Google Scholar 

  • Loh KP, Klepin HD. Geriatric assessment in acute myeloid leukemia: current and future landscape. Blood advances. 2018c;2(18):2418.

    Article  PubMed  PubMed Central  Google Scholar 

  • Loh KP, Kadambi S, Mohile SG, et al. Qualitative study of factors that influence treatment decision-making among community oncologists and older patients with acute myeloid leukemia. Blood. 2018;132(Suppl 1):2246.

    Google Scholar 

  • 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.

    Article  CAS  PubMed  Google Scholar 

  • Lowenberg B, Suciu S, Archimbaud E, et al. Use of recombinant GM-CSF during and after remission induction chemotherapy in patients aged 61 years and older with acute myeloid leukemia: final report of AML-11, a phase III randomized study of the leukemia cooperative Group of European Organisation for the research and treatment of Cancer and the Dutch Belgian Hemato-oncology cooperative group. Blood. 1997;90(8):2952–61.

    CAS  PubMed  Google Scholar 

  • 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. JClinOncol. 1998;16(3):872–81.

    Article  CAS  Google Scholar 

  • 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 

  • 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. JClinOncol. 2012;30(7):742–50.

    Article  Google Scholar 

  • Mayer RJ, Davis RB, Schiffer CA, et al. Intensive postremission chemotherapy in adults with acute myeloid leukemia. Cancer and leukemia group B. N Engl J Med. 1994;331(14):896–903.

    Article  CAS  PubMed  Google Scholar 

  • Medeiros BC, Satram-Hoang S, Hurst D, Hoang KQ, Momin F, Reyes C. Big data analysis of treatment patterns and outcomes among elderly acute myeloid leukemia patients in the United States. Ann Hematol. 2015;94(7):1127–38.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Medeiros BC, Satram-Hoang S, Momin F, Parisi M. Real-world treatment patterns and comparative effectiveness among a population of elderly patients with acute myeloid leukemia (AML). Blood. 2018;132(Suppl 1):835.

    Google Scholar 

  • Mendler JH, Maharry K, Radmacher MD, et al. RUNX1 mutations are associated with poor outcome in younger and older patients with cytogenetically normal acute myeloid leukemia and with distinct gene and MicroRNA expression signatures. JClinOncol. 2012;30(25):3109–18.

    Article  Google Scholar 

  • Mohile SG, Dale W, Somerfield MR, et al. Practical assessment and Management of Vulnerabilities in older patients receiving chemotherapy: ASCO guideline for geriatric oncology. J Clin Oncol. 2018:Jco2018788687.

    Google Scholar 

  • Molga A, Wall M, Chhetri R, et al. Geriatric assessment in older people with myelodysplasia is predictive of Azacitidine therapy completion and survival: a prospective interventional study at the Royal Adelaide Hospital. Blood. 2018;132(Suppl 1):3101.

    Google Scholar 

  • Muffly L, Pasquini MC, Martens M, et al. Increasing use of allogeneic hematopoietic cell transplantation in patients aged 70 years and older in the United States. Blood. 2017;130(9):1156–64.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • National Comprehensive Cancer Network: NCCN Clinical Practice Guidelines in Oncology: Acute Myeloid Leukemia, Version 2.2018. Available at: https://www.nccn.org/professionals/physician_gls/pdf/aml.pdf. Accessed on 9 Aug 2018.

  • NCCN. NCCN clinical practice guidelines in oncology (NCCN guidelines) older adult oncology (version 1.2019). 2019

    Google Scholar 

  • Oliansky DM, Appelbaum F, Cassileth PA, et al. The role of cytotoxic therapy with hematopoietic stem cell transplantation in the therapy of acute myelogenous leukemia in adults: an evidence-based review. Biology of blood and marrow transplantation: journal of the American Society for Blood and Marrow Transplantation. 2008;14(2):137–80.

    Article  Google Scholar 

  • Oran B, Weisdorf DJ. Survival for older patients with acute myeloid leukemia: a population-based study. Haematologica. 2012;97(12):1916–24.

    Article  PubMed  PubMed Central  Google Scholar 

  • Ostgard LS, Norgaard M, Sengelov H, et al. Improved outcome in acute myeloid leukemia patients enrolled in clinical trials: a national population-based cohort study of Danish intensive chemotherapy patients. Oncotarget. 2016;7(44):72044–56.

    Article  PubMed  PubMed Central  Google Scholar 

  • Ostir GV, Volpato S, Fried LP, et al. Reliability and sensitivity to change assessed for a summary measure of lower body function. results from the Women's Health and Aging Study J Clin Epidemiol. 2002;55(9):916–21.

    PubMed  Google Scholar 

  • Pautas C, Merabet F, Thomas X, et al. Randomized study of intensified anthracycline doses for induction and recombinant interleukin-2 for maintenance in patients with acute myeloid leukemia age 50 to 70 years: results of the ALFA-9801 study. J Clin Oncol. 2010;28(5):808–14.

    Article  CAS  PubMed  Google Scholar 

  • Pollyea DA, Stevens BM, Jones CL, et al. Venetoclax with azacitidine disrupts energy metabolism and targets leukemia stem cells in patients with acute myeloid leukemia. Nat Med. 2018;24(12):1859–66.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Prebet T, Boissel N, Reutenauer S, et al. Acute myeloid leukemia with translocation (8;21) or inversion (16) in elderly patients treated with conventional chemotherapy: a collaborative study of the French CBF-AML intergroup. JClinOncol. 2009;27(28):4747–53.

    Article  Google Scholar 

  • Rai K, Holland J, Glidewell O, et al. Treatment of acute myelocytic leukemia: a study by cancer and leukemia group B. Blood. 1981;58(6):1203–12.

    CAS  PubMed  Google Scholar 

  • Rao AV, Valk PJ, Metzeler KH, et al. Age-specific differences in oncogenic pathway dysregulation and anthracycline sensitivity in patients with acute myeloid leukemia. JClinOncol. 2009;27(33):5580–6.

    Article  CAS  Google Scholar 

  • Rashidi A, Ebadi M, Colditz GA, DiPersio JF. Outcomes of allogeneic stem cell transplantation in elderly patients with acute myeloid leukemia: a systematic review and meta-analysis. Biology of blood and marrow transplantation: journal of the American Society for Blood and Marrow Transplantation. 2016;22(4):651–7.

    Article  Google Scholar 

  • Rockwood K, Mitnitski A. Frailty in relation to the accumulation of deficits. J Gerontol A Biol Sci Med Sci. 2007;62(7):722–7.

    Article  PubMed  Google Scholar 

  • Rollig C, Thiede C, Gramatzki M, et al. A novel prognostic model in elderly patients with acute myeloid leukemia: results of 909 patients entered into the prospective AML96 trial. Blood. 2010;116(6):971–8.

    Article  CAS  PubMed  Google Scholar 

  • 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 

  • Sanz MA, Fenaux P, Tallman MS, et al. Management of acute promyelocytic leukemia: updated recommendations from an expert panel of the European LeukemiaNet. Blood. 2019;133(15):1630–1643.

    Google Scholar 

  • Scher KS, Hurria A. Under-representation of older adults in cancer registration trials: known problem, little progress. J Clin Oncol. 2012;30(17):2036–8.

    Article  PubMed  Google Scholar 

  • Schlenk RF, Frohling S, Hartmann F, et al. Intensive consolidation versus oral maintenance therapy in patients 61 years or older with acute myeloid leukemia in first remission: results of second randomization of the AML HD98-B treatment trial. Leukemia. 2006;20(4):748–50.

    Article  CAS  PubMed  Google Scholar 

  • Schwind S, Marcucci G, Maharry K, et al. BAALC and ERG expression levels are associated with outcome and distinct gene and microRNA expression profiles in older patients with de novo cytogenetically normal acute myeloid leukemia: a Cancer and leukemia group B study. Blood. 2010;116(25):5660–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Schwind S, Marcucci G, Kohlschmidt J, et al. Low expression of MN1 associates with better treatment response in older patients with de novo cytogenetically normal acute myeloid leukemia. Blood. 2011;118(15):4188–98.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • SEER. SEER 1988–2014 (SEER 13) last accessed 2.19.19. https://seer.cancer.gov/index.html/. 2019. https://seer.cancer.gov/faststats/.

  • 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  PubMed Central  Google Scholar 

  • Singh H, Beaver JA, Kim G, Pazdur R. Enrollment of older adults on oncology trials: an FDA perspective. J Geriatr Oncol. 2017;8(3):149–50.

    Article  PubMed  Google Scholar 

  • Sorror ML, Giralt S, Sandmaier BM, et al. Hematopoietic cell transplantation specific comorbidity index as an outcome predictor for patients with acute myeloid leukemia in first remission: combined FHCRC and MDACC experiences. Blood. 2007;110(13):4606–13.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Sorror ML, Storer BE, Fathi AT, et al. Development and validation of a novel acute myeloid leukemia-composite model to estimate risks of mortality. JAMA Oncol. 2017;3(12):1675–82.

    Article  PubMed  PubMed Central  Google Scholar 

  • Soubeyran P, Fonck M, Blanc-Bisson C, et al. Predictors of early death risk in older patients treated with first-line chemotherapy for cancer. JClinOncol. 2012;30(15):1829–34.

    Article  Google Scholar 

  • Stone RM, Berg DT, George SL, et al. Granulocyte-macrophage colony-stimulating factor after initial chemotherapy for elderly patients with primary acute myelogenous leukemia. Cancer and leukemia group B. N Engl J Med. 1995;332(25):1671–7.

    Article  CAS  PubMed  Google Scholar 

  • Stone RM, Berg DT, George SL, et al. Postremission therapy in older patients with de novo acute myeloid leukemia: a randomized trial comparing mitoxantrone and intermediate-dose cytarabine with standard-dose cytarabine. Blood. 2001;98(3):548–53.

    Article  CAS  PubMed  Google Scholar 

  • Stone RM, Mandrekar SJ, Sanford BL, et al. Midostaurin plus chemotherapy for acute myeloid leukemia with a FLT3 mutation. N Engl J Med. 2017;377(5):454–64.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Stresemann C, Lyko F. Modes of action of the DNA methyltransferase inhibitors azacytidine and decitabine. Int J Cancer. 2008;123(1):8–13.

    Article  CAS  PubMed  Google Scholar 

  • Studenski S, Perera S, Wallace D, et al. Physical performance measures in the clinical setting. J Am Geriatr Soc. 2003;51(3):314–22.

    Article  PubMed  Google Scholar 

  • Studenski S, Perera S, Patel K, et al. Gait speed and survival in older adults. JAMA. 2011;305(1):50–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • 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.

    Article  CAS  PubMed  Google Scholar 

  • Timilshina N, Breunis H, Tomlinson GA, et al. Long-term recovery of quality of life and physical function over three years in adult survivors of acute myeloid leukemia after intensive chemotherapy. Leukemia. 2019;33(1):15–25.

    Google Scholar 

  • Tsai CH, Hou HA, Tang JL, et al. Genetic alterations and their clinical implications in older patients with acute myeloid leukemia. Leukemia. 2016;30(7):1485–92.

    Article  CAS  PubMed  Google Scholar 

  • U.S. National Library of Medicine. “InDACtion” vs. “3+7” Induction in AML, https://clinicaltrials.gov/ct2/show/NCT02172872

  • van der Helm LH, Scheepers ER, Veeger NJ, et al. Azacitidine might be beneficial in a subgroup of older AML patients compared to intensive chemotherapy: a single Centre retrospective study of 227 consecutive patients. J Hematol Oncol. 2013;6:29.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • van der Holt B, Lowenberg B, Burnett AK, et al. The value of the MDR1 reversal agent PSC-833 in addition to daunorubicin and cytarabine in the treatment of elderly patients with previously untreated acute myeloid leukemia (AML), in relation to MDR1 status at diagnosis. Blood. 2005;106(8):2646–54.

    Article  CAS  PubMed  Google Scholar 

  • van der Holt B, Breems DA, Berna BH, et al. Various distinctive cytogenetic abnormalities in patients with acute myeloid leukaemia aged 60 years and older express adverse prognostic value: results from a prospective clinical trial. BrJHaematol. 2007;136(1):96–105.

    Google Scholar 

  • Vasu S, Kohlschmidt J, Mrozek K, et al. Ten-year outcome of patients with acute myeloid leukemia not treated with allogeneic transplantation in first complete remission. Blood Adv. 2018;2(13):1645–50.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Volpato S, Cavalieri M, Sioulis F, et al. Predictive value of the short physical performance battery following hospitalization in older patients. J Gerontol A Biol Sci Med Sci. 2011;66(1):89–96.

    Article  PubMed  Google Scholar 

  • Wass M, Hitz F, Schaffrath J, Muller-Tidow C, Muller LP. Value of different comorbidity indices for predicting outcome in patients with acute myeloid leukemia. PLoS One. 2016;11(10):e0164587.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Wei ASS, Hou J-Z, et al. Venetoclax with low-dose cytarabine induces rapid, deep, and durable responses in previously untreated older adults with AML ineligible for intensive chemotherapy. Blood. 2018b;132:284.

    Google Scholar 

  • Wei A, Strickland SA, Hou J-Z, et al. Venetoclax with low-dose Cytarabine induces rapid, deep, and durable responses in previously untreated older adults with AML ineligible for intensive chemotherapy. Blood. 2018a;132(Suppl 1):284.

    Google Scholar 

  • 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  PubMed Central  Google Scholar 

  • Whitman SP, Caligiuri MA, Maharry K, et al. The MLL partial tandem duplication in adults aged 60 years and older with de novo cytogenetically normal acute myeloid leukemia. Leukemia. 2012;26(7):1713–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Wildiers H, Mauer M, Pallis A, et al. End points and trial design in geriatric oncology research: a joint European organisation for research and treatment of cancer--Alliance for clinical trials in oncology--international society of geriatric oncology position article. J Clin Oncol. 2013;31(29):3711–8.

    Article  PubMed  Google Scholar 

  • Wildiers H, Heeren P, Puts M, et al. International Society of Geriatric Oncology consensus on geriatric assessment in older patients with cancer. J Clin Oncol. 2014;32(24):2595–603.

    Article  PubMed  PubMed Central  Google Scholar 

  • Yates JW, Wallace HJ Jr, Ellison RR, Holland JF. Cytosine arabinoside (NSC-63878) and daunorubicin (NSC-83142) therapy in acute nonlymphocytic leukemia. Cancer Chemother Rep. 1973;57(4):485–8.

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Kah Poh Loh .

Editor information

Editors and Affiliations

Section Editor information

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this entry

Check for updates. Verify currency and authenticity via CrossMark

Cite this entry

Loh, K.P., Pardee, T.S., Klepin, H.D. (2019). Acute Myeloid Leukemia in Older Adults. In: Extermann, M. (eds) Geriatric Oncology . Springer, Cham. https://doi.org/10.1007/978-3-319-44870-1_42-1

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-44870-1_42-1

  • Received:

  • Accepted:

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-44870-1

  • Online ISBN: 978-3-319-44870-1

  • eBook Packages: Springer Reference MedicineReference Module Medicine

Publish with us

Policies and ethics