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Myelodysplastic syndromes and acute myeloid leukemias in the elderly

      Highlights

      • Most patients above 60 years with acute myeloid leukemia (AML) will still die from their disease.
      • Midostaurin is added to induction therapy for older patients with a FLT3 mutation.
      • Gemtuzumab ozogamicin is added to induction therapy in patients with favorable/intermediate risk.
      • Elderly patients with APL should receive all-trans retinoic acid and arsenic trioxide.
      • Allogeneic transplantation can be recommended to selected patients up to 70–75 years.
      • For unfit patients, options are hypomethylating agents, low-dose cytarabin and supportive care.

      Abstract

      Most patients above 60 years with acute myeloid leukemia (AML) will die from their disease. Nevertheless, the treatment concepts in elderly patients with myelodysplastic syndromes (MDS) and AML are rapidly evolving. A number of recent reports have identified better survival rates with intensive induction chemotherapy for patients up to 80 years, with the exception of patients with unfavorable genomic risk abnormalities or with major co-morbidities. Gemtuzumab ozogamicin is increasingly added to induction therapy for AML patients up to 70 years with favorable or intermediate risk profile, and Midostaurin for patients with a FLT3 mutation. The recommended dose of daunorubicin is 60 mg/m2 for 3 + 7 induction therapy. Elderly patients with acute promyelocytic leukemia should receive all-trans retinoic acid and arsenic trioxide, and cytotoxic treatment is limited upfront to patients with initial leukocytosis. Allogeneic transplantation can be recommended to selected patients up to 70–75 years. For patients unfit for intensive treatment, therapeutic options comprise a hypomethylating agent (HMA), low-dose cytarabin and supportive care. HMA treatment is also increasingly applied for relapsed/refractory AML after intensive chemotherapy. A considerable number of candidate compounds are currently being studied in older AML patients, with their potential role in the treatment of elderly AML patients remaining to be clarified.

      Keywords

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