Leukemia (2014), 1 © 2014 Macmillan Publishers Limited All rights reserved 0887-6924/14 www.nature.com/leu
COMMENT
Therapy of older persons with acute myeloid leukemia RP Gale and A Hochhaus Leukemia advance online publication, 23 January 2015; doi:10.1038/ leu.2014.337
About one-half of persons with acute myeloid leukemia (AML) are more than 65 years of age and many are more than 75 years. As such, they pose a difficult therapy challenge. First, many of these persons are excluded from trials of intensive antileukemia therapy because of age (which is often inappropriately treated as a binary variable) and are not being referred for therapy, because of co-morbidities, frailty and other reasons that are sometimes difficult to identify in population-based studies. Second, older persons are even more likely to be excluded from transplant studies. Consequently, most leukemia experts agree that there is no standard of care for persons with AML who are 465 years; we are uncertain how they are best treated. Third, despite many trials of investigational drugs, none has yet proved very active in this population. Fourth, older persons with AML seem to have a different disease biology from younger persons diagnosed with AML. For example, older persons more often have an antecedent hematological disorder, such as
myelodysplastic syndrome, or are correctly or incorrectly thought to have therapy-related AML. They also have fewer residual normal hematopoietic stem cells than younger persons. In addition, there are other issues such as acquisition of mutations from aging and environmental exposures that increase genetic complexity of AML in older persons. Because of these challenges, we commissioned a mini-series focused on the therapy of AML in older persons. The first report by Walther and Estey introduces fundamental therapy issues discussed above. The second report by Montalban-Bravo and Garcia-Manero discusses new drugs currently in clinical trials in older persons in clinical trials of older persons. We hope that these reports will enlighten the readers of Leukemia and perhaps spur additional research in this area of unmet medical need. We welcome a lively correspondence on this and related issues.
CONFLICT OF INTEREST The authors declare no conflict of interest.
Division of Experimental Medicine, Haematology Research Center, London, UK Correspondence: Professor RP Gale, Division of Experimental Medicine, Haematology Research Center, London, UK. E-mail: [email protected]
COMMENT
Therapy of older persons with acute myeloid leukemia RP Gale and A Hochhaus Leukemia advance online publication, 23 January 2015; doi:10.1038/ leu.2014.337
About one-half of persons with acute myeloid leukemia (AML) are more than 65 years of age and many are more than 75 years. As such, they pose a difficult therapy challenge. First, many of these persons are excluded from trials of intensive antileukemia therapy because of age (which is often inappropriately treated as a binary variable) and are not being referred for therapy, because of co-morbidities, frailty and other reasons that are sometimes difficult to identify in population-based studies. Second, older persons are even more likely to be excluded from transplant studies. Consequently, most leukemia experts agree that there is no standard of care for persons with AML who are 465 years; we are uncertain how they are best treated. Third, despite many trials of investigational drugs, none has yet proved very active in this population. Fourth, older persons with AML seem to have a different disease biology from younger persons diagnosed with AML. For example, older persons more often have an antecedent hematological disorder, such as
myelodysplastic syndrome, or are correctly or incorrectly thought to have therapy-related AML. They also have fewer residual normal hematopoietic stem cells than younger persons. In addition, there are other issues such as acquisition of mutations from aging and environmental exposures that increase genetic complexity of AML in older persons. Because of these challenges, we commissioned a mini-series focused on the therapy of AML in older persons. The first report by Walther and Estey introduces fundamental therapy issues discussed above. The second report by Montalban-Bravo and Garcia-Manero discusses new drugs currently in clinical trials in older persons in clinical trials of older persons. We hope that these reports will enlighten the readers of Leukemia and perhaps spur additional research in this area of unmet medical need. We welcome a lively correspondence on this and related issues.
CONFLICT OF INTEREST The authors declare no conflict of interest.
Division of Experimental Medicine, Haematology Research Center, London, UK Correspondence: Professor RP Gale, Division of Experimental Medicine, Haematology Research Center, London, UK. E-mail: [email protected]
