Page 203 - Essential Haematology

Chapter 13 Acute myeloid leukaemia / 189

Ages 16–59
100
Favourable
80
71% Intermediate
Adverse
69%
Per cent alive 60 37% de novo
40
T-AML
20
12%
11%
2%
0
0 2 4 6 8 10
(a) Years from entry
Age 60+
100
80 1970–79
Per cent still alive 60 1980–84
1985–89
1990–94
1995–99
40
2000–04
20 23% 2005–09
10%
7%
4% 2% 2%
0 1%
0 5 10 15 20 25
(b) Years from entry

Figure 13.11 Overall survival for adult patients: (a) aged 16 – 59 years and grouped according to disease

karyotype and whether de novo or therapy-related (T-AML); and (b) over 60 years with AML treated in UK trials.
(Courtesy of Professor A.K. Burnett.)
with serious disease of other organs, the decision lated donor. Arsenic trioxide is useful in manage-
may be made to use supportive care with or without ment of relapse in the promyelocytic variant.
gentle single - drug chemotherapy. However, in those
otherwise well, combination chemotherapy similar Outcome
to that used in younger patients may produce long -
term remissions and reduced - intensity SCT may be The prognosis for patients with AML has been

considered. improving steadily, particularly for those under
60 years of age, and approximately one - third of
this group can expect to achieve long - term cure
Treatment of r elapse
(Fig. 13.11 a). Cytogenetic abnormalities and
Most patients suffer relapse and the outlook will initial response to treatment are major predictors of

then depend on age, the duration of the fi rst remis- favourable, intermediate or adverse prognosis.
sion and the cytogenetic risk group. In addition to Tracking of minimal residual disease using molecu-
further chemotherapy, allogeneic SCT with either lar cytogenetic markers or aberrant phenotypes may
standard or reduced - intensity conditioning is be helpful in predicting long - term remission or
usually performed in those patients who can toler- relapse. For the elderly the situation is poor and less
ate the procedure and who have a suitable human than 10% of those over 70 years of age can expect
leucocyte antigen (HLA) matching related or unre- long - term remission (Fig. 13.11 b).