PDF(Pubmed)
Abstract：
The treatment of acute myeloid leukemia (AML) in older patients is undergoing rapid changes, with a number of important publications in the past five years. Because of this, a group of Canadian leukemia experts has produced an update to the Canadian Consensus Guidelines that were published in 2013, with several new agents recommended, subject to availability. Recent studies have supported the survival benefit of induction chemotherapy for patients under age 80, except those with major co-morbidities or those with adverse risk cytogenetics who are not candidates for allogeneic hematopoietic stem cell transplantation (HSCT). Midostaurin should be added to induction therapy for patients up to age 70 with a FLT3 mutation, and gemtuzumab ozogamicin for de novo AML up to age 70 with favorable or intermediate risk cytogenetics. Daunorubicin 60 mg/m2 is the recommended dose for 3+7 induction therapy. Acute promyelocytic leukemia should be treated with arsenic trioxide plus all-trans retinoic acid, regardless of age, with cytotoxic therapy added upfront only for those with initial white blood count > 10. HSCT may be considered for selected suitable patients up to age 70-75. Haploidentical donor transplants may be considered for older patients. For non-induction candidates, azacitidine is recommended for those with adverse risk cytogenetics, while either a hypomethylating agent (HMA) or low-dose cytarabine can be used for others. HMA may also be used for relapsed/refractory disease after chemotherapy. For patients with secondary AML, CPX-351 is recommended for fit patients age 60-75.
摘要：
老年患者急性髓系白血病（AML）的治疗正在经历快速变化，在过去的五年里有许多重要的出版物。正因为如此,一组加拿大白血病专家对2013年出版的《加拿大共识指南》进行了更新，推荐了几种新药，视可用性而定。最近的研究支持了诱导化疗对80岁以下患者的生存益处，除了那些患有重大合并症或具有不利风险的细胞遗传学的患者，他们不是异基因造血干细胞移植（HSCT）的候选人。对于70岁以下具有FLT3突变的患者，应将Midostaurin添加到诱导治疗中。和吉妥珠单抗奥佐大霉素用于70岁以下具有有利或中等风险细胞遗传学的从头AML。柔红霉素60mg/m2是3+7诱导治疗的推荐剂量。急性早幼粒细胞白血病应使用三氧化二砷加全反式维甲酸治疗，不管年龄,仅对初始白细胞计数>10的患者进行细胞毒性治疗。对于70-75岁以下的选定合适患者，可以考虑使用HSCT。对于老年患者，可以考虑进行单倍体供体移植。对于非诱导候选人，阿扎胞苷建议那些有不良风险的细胞遗传学，而低甲基化药物（HMA）或低剂量阿糖胞苷可用于其他药物。HMA也可用于化疗后复发/难治性疾病。对于继发性AML患者，CPX-351建议适合60-75岁的患者。
