Acute myeloid leukemia of the elderly: recent progresses in therapy

Therapeutic modalities for acute myeloid leukemia (AML) in elderly include intensive chemotherapy, less-intensive chemotherapy, and best supportive care. The choice of treatment is based on patients' general physical condition, leukemic prognostic factors, preference of the patient/family, and the available social support. Findings of comprehensive geriatric assessment and comorbidities are considered while selecting therapeutic modalities. AML score may suggest the appropriateness of the use of intensive chemotherapy. When intensive chemotherapy is tolerable, enocitabine or cytarabine + daunorubicin is used as remission induction chemotherapy. Consolidation chemotherapy comprising three courses of cytarabine-based regimens is administered after complete remission. When intensive chemotherapy is not tolerable, low-dose cytarabine is used. CPX351, a novel antileukemic agent, is a liposomal formulation of asynergistic 5 : 1 molar ratio of cytarabine and daunorubicin. In a randomized phase 2 trial in older patients with AML, CPX351 showed better response rate and survival than cyarabine + daunorubicin regimen.