Prognostic Factors in Elderly Patients with Acute Myeloid Leukemia: Trying to Make the Best of a Bad Situation

Abstract

The clinical outcome of acute myeloid leukemia (AML) is extremely variable, ranging from survival of a few days to cure. Different clinical and biologic features at diagnosis have been reported as useful for the prediction of clinical outcome; however, in most AML cases, induction therapy must be initiated as soon as possible. Therefore, the possibility of stratifying patients at diagnosis is generally not taken into account, with the exception of acute promyelocytic leukemia in which morphology, immunophenotype, and molecular biology allow rapid diagnosis and the adoption of a specific therapy. As a consequence, prognostic factors in AML are more useful for the prediction of relapse rather than for the stratification of induction therapy. However, a further exception is represented by a considerable proportion of elderly patients, in whom the potential benefits of an aggressive approach are not commensurate with the risks. Nevertheless, in order to achieve the best therapeutic results and avoid unnecessary toxicity, it would be of major clinical use to determine which patients will do well with some types of treatment and not others. This is particularly relevant in AML of the elderly because the > 15% risk of death in the month after the start of treatment is difficult to justify because of median survivals of < 1 year in the patients who do not die early. Therefore, factors other than age significantly influencing survival would be considered and taken into account as soon as diagnosis in the process of therapeutic decision-making.