Introduction: Acute Leukemia in the Elderly

Article Outline

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It is readily accepted that the prognosis of older patients with acute leukemia is extraordinarily poor. To a large extent this reflects our lack of knowledge about the differences between the blasts seen in acute leukemia and their normal counterparts. Exploration of the etiology and epidemiology of acute myeloid leukemia (AML) in the elderly may help us understand these distinctions. Accordingly, the first chapter in this issue of Seminars, by David Bowen, discusses the etiology of AML in the elderly. The chapter emphasizes the interplay between environmental factors and polymorphic variants in several genes responsible for maintaining the integrity of the genome. In the second chapter, Dr Estey focuses on the general management of AML in the elderly and in particular on which patients are candidates for clinical trials of new drugs, for standard therapy, or for palliative care. The topic of new drugs is pursued in much more depth by Burnett and Mohite. Both this chapter and Estey’s propose new designs for clinical trials in older patients; these designs are intended to allow more rapid screening of the large number of therapies that will become available in the future. Novel therapies are further discussed by De Lima and Giralt and by Farag and Caligiuri. In the former, the authors describe the applicability of reduced intensity allogeneic transplantation in older patients. It is clear that such “mini-transplants” have extended the age limit beyond which transplantation can be performed. The latter chapter notes recent advances in understanding the importance of natural killer (NK) cell receptors in recognizing and lysing AML cells, emphasizing strategies to harness NK cells. Although AML is considerably more frequent, older patients can also develop acute lymphoblastic leukemia (ALL). Thus, Richard Larson discusses management of ALL in older patients, stressing the frequency of Philadelphia chromosome (BCR/ABL)-positive ALL in older patients and the resultant potential for use of tyrosine kinase inhibitors. Older patients with acute leukemia are obviously more prone than younger patients to develop complications of these diseases and their treatment. Thus, in the final chapter Gingerich and Bow describe methods to predict risk of these complications in various types of older patients and discuss methods for managing common sequelae of treatment, such as mucositis and infection.

We hope the readers find this issue of Seminars both informative and thought-provoking.